Methods and compositions for panic disorders

ABSTRACT

Methods and compositions that down regulate the activity of orexins to treat panic disorder and panic-like responses associated with hypercapnic conditions are disclosed.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority under 35 USC §119(e) to U.S.Provisional Application Ser. No. 61/254,689 filed on Oct. 24, 2009, andU.S. Provisional Application Ser. No. 61/388,965 filed on Oct. 1, 2010,the entire disclosures of each of which are incorporated herein byreference

TECHNICAL FIELD

The disclosure relates to the fields of neuroscience and psychiatry. Inparticular, the disclosure relates to methods and compositions fortreating symptoms related to panic disorder and hypercapnic conditions.

BACKGROUND AND SUMMARY

A ‘panic’ response is a normal physiological survival reflex in humansand can be elicited by either an exteroceptive or interoceptive cueperceived as life-threatening. Panic disorder is characterized byrecurrent episodes of severe anxiety accompanied by multiple physicalsymptoms such as increased cardiorespiratory responses. Panic disorderis also a risk factor for suicidal behavior.

The initial pathology in patients with panic disorder appears to be analteration in central neural pathways regulating normal panic responses,thus rendering the patients susceptible to unprovoked panic symptomswhen exposed to ordinarily mild stressors.

Panic attacks can be reliably induced in panic disorder patients in thelaboratory by specific, normally innocuous interoceptive stimuli (e.g.,intravenous 0.5M sodium lactate or yohimbine, or 7% CO₂ inhalations).These induced attacks are similar to spontaneously occurring episodesthat characterized by sudden onset of fear symptoms along with rapidincreases in respiration and heart rates. This indicates that globalneural pathways that modulate arousal are perturbed in these patients.Consistent with this, reduced central GABAergic activity has beenreported in subjects with panic disorder and drugs that restoreGABAergic inhibition (e.g. benzodiazepines) have been used astreatments. Furthermore, acute disruption of GABAergic inhibition inpanic-generating CNS sites such as the dorsomedial/periformicalhypothalamus, amygdala or the dorsal periaqueductal grey leads topanic-like behavior and increased cardiorespiratory responses in rats.After chronically inhibiting GABA synthesis in thedorsomediaUperiformical hypothalamus of rats with 5 days of local1-allylglycine (1-AG: a GABA synthesis inhibitor) infusions (usingosmotic minipumps connected to a cannula directed atdorsomedial/periformical hypothalamus), sodium lactate challengesproduce anxiety (measured by social interaction, elevated plus maze,open field test, and freezing in defensive probe burying test) as wellas panic (characterized as increased “flight”-like locomotion andincreased heart rate, mean arterial pressure responses). This is alsopharmacologically validated with anti-panic drugs such as alprazolam,and provides a robust animal model of human sodium lactate-induced panicattacks.

Orexins (ORX), also called hypocretins (Hcrt), are neuroactive peptidesthat are produced by neurons located in the dorso-medial periformicaland lateral hypothalamic areas of the brain. Orexin A and orexin B arehypothalamic peptides derived from a common precursor polypeptide calledprepro-orexin. Human prepro-orexin mRNA encodes a 131-residue precursorpeptide (prepro-orexin). The human prepro-orexin gene consists of twoexons and one intron distributed over 1432 base pairs. The 143-base pairfirst exon includes the 5′-untranslated region and a small part of thecoding region that encodes the first seven residues of the secretorysignal sequence. The second exon contains the remaining portion of theopen reading frame and 3′-untranslated region. Human pre-pro orexin mRNAhas been characterized by Sakurai et al, J. Biol. Chem. 274(25):17771-17776 (1999), the content of which is herein incorporated byreference in its entirety.

Prepro-orexin is processed to form pro-orexin, which is furtherprocessed to form orexin A and orexin B. Orexin A is a 33-amino acidpeptide of 3562 Da with two sets of intrachain disulfide bonds. It hasan N-terminal pyroglutamyl residue and C-terminal amidation. The primarystructure of orexin A predicted from the cDNA sequences is completelyconserved among several mammalian species (human, rat, mouse, cow,sheep, dog, and pig). On the other hand, rat orexin B is a 28-aminoacid, C-terminally amidated linear peptide of 2937 Da that is 46%(13/28) identical in sequence to orexin A. The C-terminal half of orexinB is very similar to that of orexin A (73%; 11/15), whereas theN-terminal half is variable.

Orexin A and Orexin B are endogeneous peptides that activate orexinreceptors, for example, orexin receptor type 1 (OX1R) and orexinreceptor type 2 (OX2R), which are G-protein coupled receptors.Stimulation of these receptors by orexins causes an increase inintracellular calcium levels in hypothalamic cells in vitro. Thesehypothalamic neurons are the origin of an extensive and divergentprojection system innervating numerous structures of the central nervoussystem.

ORX producing neurons in the dorsomedial/periformical and lateralhypothalamus and are known to regulate feeding, wakefulness andvigilance. It has been discovered herein that ORX neurons are involvedin mobilizing sympathetic responses and desensitizing theparasympathetically mediated baroreflex to permit simultaneous increasesof blood pressure and heart rates, which are all components of panic.These autonomic nervous system targets of ORX neurons are activated bysodium lactate infusions in sodium lactate panic prone rats but not incontrols. Mice lacking the prepro-ORX gene have attenuated defenseresponses to panic cues and cardioexcitatory responses followingdisinhibition of the dorsomedial/periformical hypothalamus.

Acute hypercapnia (elevated arterial CO₂), rapidly increasesextracellular pH when elevated levels of plasma CO₂ combine with waterto form carbonic acid. Hence, the concentration of CO₂ in the blood ishighly regulated and maintained within a very narrow range. Mildelevations of CO₂ initially increase respiration rate and tidal volumeto help “blow off” excess CO₂. However, as CO₂ levels continue toincrease, additional physiologic responses are initiated, includingadaptive autonomic, behavioral and neuroendocrine responses. Forinstance, exposing rats to mildly elevated concentrations of hypercarbicgas (e.g., 7% CO₂) results in increased respiration rate and tidalvolume that serve to reduce partial pressure of CO₂ (PCO₂) withoutmobilizing other components of the “panic-like” response. However,exposing rats to higher concentrations of hypercarbic gas (e.g., ≧10%CO₂) elicits additional components of a full blown panic-like responseas evidenced by increases in sympathetic activity, hypertension,anxiety-like behaviors and mobilization of thehypothalamic-pituitary-adrenal (HPA) axis.

Acute hypercapnia (elevated arterial CO₂) can be life-threatening andrapidly mobilizes adaptive changes in breathing and behavioral arousalin order to restore acid-base homeostasis. Severe hypercapnia, seenacutely in sleep disorders (e.g., sleep apnea) or chronically inrespiratory disorders (e.g., chronic obstructive pulmonary disease,COPD), also results in high anxiety and autonomic activation. Recentevidence has demonstrated that hypothalamic orexin (ORX: also known ashypocretin) neurons, which help to maintain waking states and vigilance,are Sensitive to local changes in CO₂/H⁺ through acid-induced closure ofleak-like K+ channels, and mice lacking prepro-orexin have bluntedrespiratory responses to hypercapnia.

Severe hypercapnia-induced autonomic hyperactivity and anxiety responsesare relevant to managing hypercapnic conditions such as chronicobstructive respiratory disease (COPD), obstructive sleep apnea syndrome(OSAS), sudden infant death syndrome (SIDS), congestive heart failure,emphysema, asthma, bronchitis, pneumonia, cystic fibrosis, and alpha-1antitrypsin, deficiency. In humans, even a single breath of aircontaining 35% CO₂ mobilizes sympathetic-adrenal responses and increasesanxiety-like symptoms. However, the mechanism by which high CO₂ levelselicit panic-like responses is heretofore unknown.

Although the carotid body is the primary peripheral CO₂/pHchemoreceptor, CO₂ readily crosses the blood-brain barrier to directlyinteract with central chemoreceptive neurons. Specialized CO₂/H+chemosensory neurons with a high chemosensitivity (˜300%, ˜110% or ˜120%increase in firing rate with 0.1 unit extracellular pH change,respectively) are found in medullary regions such as the retrotrapezoidnucleus, medullary raphe, and ventrolateral medulla. Without being boundby theory, it is believed herein that medullary chemosensitive neuronsare important for regulating breathing following subtle changes inCO₂/H+ due to their proximity to major cerebral arteries and the brainsurface. The ORX producing neurons, which are localized to thedorsomedial/perifornical (DMH/PeF) and adjacent lateral hypothalamus(LH) also display CO₂/H+-sensitive properties, but with lesserchemosensitivity (˜100% increase in firing rate with 0.1 unitextracellular pH change).

Subjects with chronic episodes of hypercapnia (such as patientssuffering from a chronic pulmonary disease including asthma, chronicobstructive pulmonary disease (COPD), pulmonary fibrosis, cysticfibrosis, and sarcoidosis) have significant co-morbidity with severeanxiety and sympathetic arousal, both of which can make management ofthese patients difficult. It is discovered herein that the orexin systemplays an important role in responses to hypercapnia, particularly withconcomitant severe anxiety. Current treatments of anxiety, such as fastacting benzodiazepine drugs, are not ideal for treating anxietyassociated with hypercapnic conditions due to significant respiratorydepression and other peripheral side effects. Thus, new therapies thatcan reduce or alleviate symptoms associated with panic disorder,anxiety, and hypercapnic conditions are desired.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows orexin levels in cerebrospinal fluid of human patients.

FIG. 2 shows c-Fos immunoreactive neurons in DMH/PeF and LH hypothalamicregions in panic-prone (1-AG treated) and control (d-AG treated) rats.

FIG. 3 shows social interaction in panic prone rats in response toinjections of small interfering RNA targeting prepro-orexin (siORX) orcontrol (siCON) and sodium lactate or vehicle.

FIG. 4 shows locomotor activity in panic prone rats in response toinjections of small interfering RNA targeting prepro-orexin (siORX) orcontrol (siCON) and sodium lactate or vehicle.

FIG. 5 shows heart rate in panic prone rats in response to injections ofsmall interfering RNA targeting prepro-orexin (siORX) or control (siCON)and sodium lactate or vehicle.

FIG. 6 shows mean arterial pressure in panic prone rats in response toinjections of small interfering RNA targeting prepro-orexin (siORX) orcontrol (siCON) and sodium lactate or vehicle

FIG. 7 shows prepro-orexin mRNA levels in DMH/LH in response toinjections of siORX or siCON.

FIG. 8 shows pro-dynorphin (pDyn) mRNA levels in DMH/LH in response toinjections of siORX or siCON.

FIG. 9 shows pro-opiomelanocortin (POMC) mRNA levels in DMH/LH inresponse to injections of siORX or siCON.

FIG. 10 shows social interaction after sodium lactate (NaLac) challengein panic prone rats pre-treated with systemic injections of SB334867(SB33) or alprazolam (Alpr).

FIG. 11 shows locomotor activity after sodium lactate (NaLac) challengein panic prone rats pre-treated with systemic injections of SB334867(SB33) or alprazolam (Alpr).

FIG. 12 shows heart rate after sodium lactate (NaLac) challenge in panicprone rats pre-treated with systemic injections of SB334867 (SB33) oralprazolam (Alpr).

FIG. 13 shows mean arterial pressure after sodium lactate (NaLac)challenge in panic prone rats pre-treated with systemic injections ofSB334867 (SB33) or alprazolam (Alpr).

FIG. 14 shows open field test results after sodium lactate (NaLac)challenge in panic prone rats pre-treated with systemic injections ofSB334867 (SB33).

FIG. 15 shows locomotor activity after sodium lactate (NaLac) challengein panic prone rats pre-treated with systemic injections of SB334867(SB33).

FIG. 16 shows heart rate after sodium lactate (NaLac) challenge in panicprone rats pre-treated with systemic injections of SB334867 (SB33).

FIG. 17 shows mean arterial pressure after sodium lactate (NaLac)challenge in panic prone rats pre-treated with systemic injections ofSB334867 (SB33).

FIG. 18 shows social interaction after sodium lactate (NaLac) challengein panic prone rats pre-treated with systemic injections of SB408124(SB40).

FIG. 19 shows locomotor activity after sodium lactate (NaLac) challengein panic prone rats pre-treated with systemic injections of SB408124(SB40).

FIG. 20 shows heart rate after sodium lactate (NaLac) challenge in panicprone rats pre-treated with systemic injections of SB408124 (SB40).

FIG. 21 shows mean arterial pressure after sodium lactate (NaLac)challenge in panic prone rats pre-treated with systemic injections ofSB408124 (SB40).

FIG. 22 shows defensive shock associated behaviors (a), line crossings(b), and social interaction (c) after sodium lactate challenge in panicprone rats pre-treated with SB334867 (SB33) or vehicle (Veh).

FIG. 23 shows acoustic startle responses in response to 1-AG infusionsinto the DMH/PeF.

FIG. 24 shows mean arterial pressure after infusion of hypercapnic oratmospheric air.

FIG. 25 shows heart rate after infusion of hypercapnic or atmosphericair.

FIG. 26 shows number of fecal pellets after infusion of hypercapnic(CO₂) or atmospheric (Atm) air.

FIG. 27 shows open field test results after infusion of hypercapnic(CO₂) or atmospheric (Atm) air.

FIG. 28 shows number of c-Fos/orexinA immunoreactive (c-Fos/ORXA-ir)neurons in DMH/PeF and LH hypothalamic regions at −2.93 mm to Bregmafollowing exposure to hypercapnic or atmospheric air.

FIG. 29 shows number of c-Fos/orexinA immunoreactive (c-Fos/ORXA-ir)neurons in DMH/PeF and LH hypothalamic regions at −3.12 mm to Bregmafollowing exposure to hypercapnic (CO₂) or atmospheric (Atm) air.

FIG. 30 shows expression level of prepro-orexin mRNA in combinedDMH/Pe/LH hypothalamic regions following exposure to hypercapnic (CO₂)or atmospheric (Atm) air.

FIG. 31 shows mean arterial pressure during infusion of hypercapnic andatmospheric air in rats pre-treated with SB334867 or vehicle.

FIG. 32 shows heart rate during infusion of hypercapnic and atmosphericair in rats pre-treated with SB334867 or vehicle.

FIG. 33 shows number of fecal pellets during infusion of atmospheric airand during infusion of hypercapnic air in rats pre-treated with vehicle(solid bar) or SB 334867 (hatched bar).

FIG. 34 shows open field test results after infusion of atmospheric air(Atm) or hypercapnic air (CO₂) in rats pre-terated with vehicle (veh) orSB 334867 (SB).

FIG. 35 shows number of c-Fos immunoreactive and orexin immunoreactivecells in DMH/PeF and LH hypothalamic regions following treatment withsaline (Sal), caffeine (Gaff) or FG-7142 (FG).

FIG. 36 shows open field test results in response to challenge withvehicle (Veh) or FG-7142 in rats pre-treated with vehicle or SB334867(SB33).

FIG. 37 shows social interaction at baseline and in response tochallenge with vehicle (Veh) or FG-7142 in rats pre-treated with vehicleor SB334867 (SB33). A=baseline; B=Veh/Veh; C=Veh/FG; D=SB/FG.

FIG. 38 shows number of c-Fos immunoreactive cells in hypothalamic,extended amygdala, periaqueductal grey, and rostral ventrolateralmedulla brain regions in response to challenge with vehicle (Veh) orFG-7142 (FG) in rats pre-treated with vehicle or SB334867 (SB33).

DETAILED DESCRIPTION

In describing and claiming the invention, the following terminology willbe used in accordance with the definitions set forth below.

The term “about” as used herein means greater or lesser than the valueor range of values stated by 10 percent, but is not intended todesignate any value or range of values to only this broader definition.Each value or range of values preceded by the term “about” is alsointended to encompass the embodiment of the stated absolute value orrange of values.

As used herein the term “pharmaceutically acceptable salt” refers tosalts of compounds that retain the biological activity of the parentcompound, and which are not biologically or otherwise undesirable.

As used herein, the term “treating” includes prophylaxis of the specificdisorder or condition, or alleviation the symptoms associated with aspecific disorder or condition and/or preventing or eliminating saidsymptoms.

As used herein the term “orexin activity” is intended to include bindingof one or more orexins (e.g., orexin A or orexin B) to G-protein coupledorexin receptors (orexin 1 receptors and/or orexin 2 receptors) andactivation of signal transduction pathways.

As used herein the term “chronic pulmonary disease” is intended toinclude any condition that occurs in the lungs or that causes the lungsto not work properly. Examples of chronic pulmonary disease includeasthma, chronic obstructive pulmonary disease, pulmonary fibrosis,cystic fibrosis, and sarcoidosis.

As used herein the term “obstructive pulmonary disease” is intended toinclude any condition that restricts airflow to and from the lungs.

As used herein the term “chronic obstructive pulmonary disease” (COPD)refers to diseases of the lungs, including chronic bronchitis andemphysema, in which the airways become narrowed, limiting the flow ofair to and from the lungs.

As used herein an “effective” amount or a “therapeutically effectiveamount” of an agent that downregulates orexin activity refers to anontoxic but sufficient amount of an agent to provide the desiredeffect. For example, a desired effect would be preventing the onset, orreducing the severity, frequency or duration of symptoms associated withpanic disorder and/or hypercapnia-induced anxiety or hypertensiveresponse. The amount that is “effective” will vary from subject tosubject, depending on the age and general condition of the individual,mode of administration, and the like. Thus, it is not always possible tospecify an exact “effective amount.” However, an appropriate “effective”amount in any individual case may be determined by one of ordinary skillin the art using routine experimentation.

As used herein the term “individual” without further designation isintended to encompass any warm blooded vertebrate domesticated animal(including for example, but not limited to livestock, horses, cats, dogsand other pets) and humans.

In one embodiment, a method of reducing one or more symptoms associatedwith panic disorder in an individual is described. The method comprisesadministering to the individual suffering from panic disorder acomposition comprising a therapeutically effective amount of an agent todown regulate the activity an orexin at one or more orexin receptors.

In one embodiment, a method of treating symptoms associated withhypercapnia or a hypercapnic condition in an individual is described.The method comprises administering to the individual a compositioncomprising a therapeutically effective amount of an agent to downregulate the activity of an orexin at one or more orexin receptors.

In one embodiment, the method comprises administering an agent effectiveto reduce the expression of prepro-orexin. The expression ofprepro-orexin may be reduced, for example, by a siRNA. Reducing theexpression of prepro-orexin is understood to result in the reduction oforexin A and/or orexin B peptide levels and a decrease in activity atorexin 1 receptors and/or orexin 2 receptors.

In one embodiment, the method comprises administering a compositioncomprising an agent effective to reduce the expression of orexin 1receptors. In one embodiment, the agent is effective to reduce theexpression of orexin 2 receptors. The expression of orexin 1 receptorsor orexin 2 receptors may be reduced for example, by a siRNA.

In one embodiment, the method comprises administering a compositioncomprising one or more orexin receptor antagonists. Illustrativeexamples of non-peptide orexin receptor antagonists include, but are notlimited to, SB334867, SB408124, MK4305, almorexant, and those describedin PCT Patent Application Publications WO 01/96302, WO 01/68609, WO02/51232, and WO 02/51838.

In one embodiment, the method comprises administering a compositioncomprising an agent that antagonizes orexin 1 receptors. In oneembodiment, the method comprises administering a composition comprisingan agent that antagonizes orexin 2 receptors. In one embodiment, theagent antagonizes orexin 1 receptors and orexin 2 receptors. The agentmay be a peptide or a non-peptide. Peptide agents include amino acidanalogs, derivatives, and peptide mimetics.

In one embodiment, the agent is an antagonistic antibody or single chainantibody fragment that binds to orexin A. In one embodiment, the agentis an antagonistic antibody or single chain antibody fragment that bindsto orexin B. It is appreciated that the antibody may bind to both orexinA and orexin B. In one embodiment, the agent is an antibody or antibodyfragment that binds to orexin 1 receptors. In one embodiment, the agentis an antibody or antibody fragment that binds to orexin 2 receptors. Itis appreciated that the antibody may bind to both orexin 1 and orexin 2receptors.

Single-chain antibody fragments (scFv) that may provide a targetingmechanism to help drugs cross the blood-brain barrier are capable ofbeing used either alone or in combination with an orexin receptorantagonist. For example, a human scFv that specifically binds to brainendothelial cell receptors and may pass through the blood-brain barrieris a suitable candidate. Drugs or drug carriers including orexinreceptor antagonists can be attached to these scFv fragments anddelivered into the brain.

Antibodies are also suitable for use as orexin receptor antagonists. Forexample antagonistic antibodies that target orexin receptors and able tocross the blood brain barrier are particularly well-suited. For example,antibodies capable of utilizing the receptor-mediated transcytosissystems are suitable. As examples, antibodies that recognizeextracellular epitopes of receptor mediated endocytosis and also capableof specifically targeting or blocking orexin receptors are useful.

Additionally, such antibodies capable of crossing the blood-brainbarrier may also be conjugated or linked to carry small molecule drugsas orexin receptor antagonists. Liposomes and liposomes containingsiRNAs are also suitable for delivery of drugs to the brain either aloneor in combination the antibodies discussed herein. Brain delivery of theRNA interference drugs via pegylated (polyethylene glycol attachment)immunoliposomes is also suitable.

In one embodiment, the hypercapnic condition is selected from chronicpulmonary disease, chronic obstructive pulmonary disease (COPD),obstructive sleep apnea syndrome (OSAS), sudden infant death syndrome(SIDS), sarcoidosis, Pickwick's syndrome, and/or congestive heartfailure.

In one embodiment, hypercapnia symptom is selected from hypertension,anxiety, elevated sympathetic nervous system activity, and/or elevatedrespiration.

In one embodiment, the reduction in one or more symptoms of the panicdisorder or hypercapnia is not accompanied by a general induction ofsedation.

In one embodiment, a method of predicting whether an individualsuspected of suffering from panic disorder will respond to a treatmentto downregulate the activity of an orexin at one or more orexinreceptors is described. The method comprises determining the levels ofan orexin in a biological sample, and predicting that the individualwill respond to the treatment if the orexin levels are higher in theindividual compared to a control. In one embodiment, the biologicalsample is cerebrospinal fluid.

In one embodiment, a method of determining whether an individual isresponsive to a treatment for panic disorder or a hypercapnic,associated disorder is described. The method comprises determining thelevels of orexin in a biological sample from the individual during orafter a treatment period, comparing the levels of orexin the sample tobaseline levels prior to treatment, and determining that the individualis responsive to treatment if orexin levels are reduced during or aftera treatment period. The treatment may include agents that directly orindirectly mediate orexin activity at one or more orexin receptors.

In one embodiment a method is provided for treating ahypercapnia-induced anxiety or hypertensive response. In one embodimentthe method comprises administering a composition comprising an inhibitorof orexin activity. The composition can be administered prophylacticallyor can be administered at the onset of the symptoms. In one embodiment amethod of treating symptoms associated with a patient suffering from achronic pulmonary disease is provided wherein the method comprisesadministering to said patient a composition comprising an inhibitor oforexin activity. In one embodiment the chronic pulmonary disease ischronic obstructive pulmonary disease.

It is appreciated herein that compositions comprising one or more agentsmay include pharmaceutically acceptable carriers. Pharmaceuticallyacceptable carriers include any of the standard pharmaceutical carriers,such as a phosphate buffered saline solution, water, emulsions such asan oil/water or water/oil emulsion, and various types of wetting agents.Pharmaceutically acceptable carriers also encompass any of the agentsapproved by a regulatory agency of the US Federal government or listedin the US Pharmacopeia for use in animals, including humans.

It is appreciated herein that one or more agents may be in the form of apharmaceutically acceptable salt.

It is to be understood that the composition may be administered orallyor parenterally. Parenteral routes of administration include any meansnot through the alimentary canal, but by some other route including butnot limited to, intranasal, inhalation, subcutaneous, intramuscular,intraventricular, intraspinal, intrarectal, or intravenous.

Utilizing an established panic model it is discovered herein thatORX-positive cells (specifically those in the dorsomedial/periformicalhypothalamus) are activated (i.e., increased c-Fos) following sodiumlactate administration in panic-prone rats, and was correlated withincreases in anxiety-related behavior. This panic-related c-Fosexpression was not observed in adjacent cells positive for melaninconcentrating hormone.

It is also discovered herein that sodium lactate-induced panic responsesare dependent on translation of the gene that produces ORX,preproOrexin. Translation of this gene was silenced by injecting smallinterfering RNA (siRNA) targeting the preproORX mRNA (siORX)(OnTargetP/us SmartPool® Dharmacon, Inc., Lafayette, Colo.) into thedorsomedial/periformical hypothalamus of panic-prone rats 48 h prior tosodium lactate or saline challenges. Quantitative RT-PCR was used toassess mRNA levels in the combined dorsomedial and lateral hypothalamus.Injecting panic-prone rats with siORX attenuated all components of thesodium lactate-induced panic-like responses (anxiety-like behavior,locomotor, and cardioexcitatory effects, whereas control rats displayedthe predicted panic-like responses. The siORX treated rats had a smallbut significant reduction of blood pressure following saline. These ratshad elevated baseline blood pressure. Treatment with siORX significantlyreduced local preproORX mRNA in control and panic-prone rats compared totreatment with control siRNA. The effect was selective, as neitherpro-dynorphin mRNA (a gene selectively co-expressed in ORX neurons; norlocal pro-opiomelanocortin mRNA was reduced by siORX injection.Interestingly, panic-like responses following sodium lactate infusionsappear to rapidly suppress both preproORX and pro-dynorphin mRNA levelsin panic-prone rats compared to siCON challenged and control rats, whichmay suggest panic-induced negative feedback.

It is also demonstrated that sodium lactate-induced panic is attenuatedby systemic pre-treatment with orexin receptor antagonists. A selectiveORX1 receptor antagonist (SB334867, 30 mg/kg, Tocris) attenuated theanxiety-like behavior (measured with social interaction and open fieldtests. The ORX1 receptor antagonist also blocked the increases inlocomotion, blood pressure and heart rate responses induced by thesodium lactate challenge. These effects mimicked the anti-panic effectsthat were observed when pre-treating the rats with alprazolam (3 mg/kg,Sigma, a clinically administered anti-panic benzodiazepine that blocksspontaneous and sodium lactate-induced panic attacks in patients.Similarly, a second ORX1 receptor antagonist (SB408124, 30 mg/kg,Tocris) also attenuated the sodium lactate-induced increases inlocomotor activity and tachycardia responses in another group ofpanic-prone rats. The SB334867 ORX1 antagonist did not alter anxiety orcardiovascular responses in control rats or baseline measures inpanic-prone rats.

A potential concern is that blocking ORX function might induce generalsomnolence or narcoleptic behavior, which may be the reason for thecessation of sodium lactate-induced panic responses. This may not be thecase for the following reasons: acute blockade of ORX receptors did notresult in narcoleptic states; and reducing ORX activity for shortperiods with either ORX 1 receptor antagonists or gene silencing did notresult in somnolence during testing or alter baseline locomotoractivity. In fact, the ORX gene silencing or an ORX1 receptor antagonistincreased social interaction and exploration in the open field, clearlyarguing against induction of sedation. In addition to its attenuation ofpanic-like responses, the ORX1 receptor antagonist (SB334867, 30 mg/kgi.p.) also blocks sodium lactate-induced freezing (indicative ofpanic-like fear) observed in the defensive burying test in panic-pronerats. This is not likely due to sedative effects of the ORX1 antagonist,since the number of mid-line crossings was not reduced in the treatedpanic-prone rats.

The sodium lactate-induced anxiety, but not the cardiorespiratorycomponents of the panic response, appears to be linked to the bednucleus of the stria terminalis. Therefore, to confirm an end targeteffect of activating ORX neurons, the bed nucleus of stria terminaliswhich receives ORX projections from the dorsomedial/periformicalhypothalamus was focused upon. An ORX1 receptor antagonist (SB334867)was injected ipsilaterally into the bed nucleus of the stria terminalisof 1-AG treated panic-prone rats, prior to the sodium lactate challenge,which reduced anxiety-like behavior compared to the vehicle-injectedrats.

The animal model of panic disorder utilized herein was established overthe last 10 years and has robust face, predictive and constructvalidity. The model's predictive validity is demonstrated by responses,similar to those observed in patients with panic disorder, to bothpanic-inducing agents (e.g. sodium lactate, yohimbine, and inhalationsof CO₂) and anti-panic effects of therapeutic agents such as alprazolamand group II metabotropic glutamate agonists. Also, this animal modelwas recently used in a series of preclinical studies to identify a novelclass of translocator protein agonist (that enhances the centralinhibitory effects of GABA), which subsequently showed anti-panicproperties in clinical trials, further strengthening the model'spredictive validity. The construct validity of this model is supportedby the fact that neural circuits of the dorsomedial/periformicalhypothalamus regulate behavioral and autonomic components of the “fightor flight” response in rats, and are implicated in eliciting panic-likeresponses in humans and animals. Furthermore, panic disorder patientshave reported deficits in central GABA activity and pharmacologicalrestoration of central GABA activity prevents panic attacks, inaccordance with the animal model used herein. Also, the panic- andanxiety-like responses noted in this model are not likely due to ageneral increase in arousal, as there are no changes in baselineacoustic startle responses. Similarly, there is no increase in baselinestartle response in human subjects with panic disorder. Therefore, theanimal models used herein provide reasonable correlation to therapeuticeffects of the methodologies used herein to individuals suffering frompanic disorder.

The translational experiments in animal models and patients indicatethat aberrant functioning of the ORX system underlies panic-attacks.Downregulation of ORX activity provides a novel therapeutic approach forthe treatment of panic disorder.

Orexins also mediate hypercapnia-induced autonomic hyperactivity andanxiety responses psychological and physiological responses tohypercapnic conditions. As described herein, orexins play a role in thefunctional responses to acute exposure to 20% CO₂/normoxic gas. Exposingconscious rats to hypercapnic air resulted in pressor and bradycardicresponses, enhanced anxiety-like behavior, increased cellular c-Fosresponses in orexin neurons, and decreased hypothalamic ORX mRNA.Pre-treating rats with a centrally active inhibitor of orexin activity,the ORX1 receptor antagonist (SB334867 30 mg/kg, i.p.), attenuatedhypercapnic gas-induced pressor and anxiety responses, without alteringthe robust bradycardia response.

Orexin has been discovered to be hyperactive during acute exposure to20% CO₂/normoxic gas which leads to pressor and anxiety responses. Thus,downregulation of orexin activity at orexin receptors is a treatmentoption for treating hypercapnia-induced autonomic hyperactivity andanxiety responses.

The role of orexin in the functional responses to acute exposure to 20%CO₂/normoxic gas is described herein. Exposing conscious rats to suchhypercapnic, but not atmospheric air, resulted in pressor andbradycardic responses, enhanced anxiety-like behavior, increasedcellular c-Fos responses in orexin neurons, and decreased hypothalamicORX mRNA. Pre-treating rats with a centrally active orexin receptorantagonist (30 mg/kg SB334867 i.p.) attenuated hypercapnic gas-inducedpressor and anxiety responses, without altering the robust bradycardiaresponse. Orexin receptor antagonists are useful to treat increasedsympathetic drive and anxiety as seen in hypercapnic states such asCOPD.

EXAMPLES Example Experiment 1. Orexin Levels in Human CerebrospinalFluid

To further validate the role of ORX in panic disorder, cerebrospinalfluid (CSF) samples were collected from 53 medication-free patients whopresented with suicidal behavior. A cohort of subjects who presentedwith acute suicidal thoughts/behaviors was systematically assessed withpsychiatric symptoms utilizing the comprehensive psychiatric ratingscale (CPRS), and item 3 (inner tension) on that scale that assessespanic and anxiety. A threshold cut off at 1.5 on this scale was used todefine a patient as having significant panic symptoms. Lumbar punctureswere performed to collect cerebrospinal fluid (CSF), and samples storedin −80° C. until assay performed. CSF-ORX-A levels were measured usingcommercially available ¹²⁵I radioimmunoassay (RIA) kits (PhoenixPharmaceuticals) using protocols provided by Phoenix Pharmaceuticals.Duplicate samples were assayed and levels were determined against aknown standard. All patients with substance abuse and traces ofmedication in the blood were excluded from the analysis. Increased CSFORX was observed in patients with panic anxiety compared to subjectswithout panic anxiety. Furthermore, patients with only panic anxiety hadsignificantly higher CSF ORX than subjects with panic anxiety andco-morbid major depressive disorder (see FIG. 1 for details). IncreasedORX levels are therefore present in patients with panic anxiety.

Analyses of the CSF ORX levels (FIG. 1 a) using Kruskal-Wallis ANOVAshowed significant differences between the groups, P=0.004. Patientswith panic and without MDD had the highest CSF orexin levels compared toboth patients with panic and co-morbid MDD (Mann-Whitney U-test,p=0.002, two-tailed) and patients without panic (p=0.01, two-tailed).Age and gender did not have any impact on CSF ORX levels (Pearsons R andMann-Whitney U-tests, P>0.1).

Example Experimental Materials and Methods for Preclinical Experiments

Animals and housing conditions: All experiments used adult maleSprague-Dawley rats (300-350 g, Harlan Laboratories). Rats were housedindividually in plastic cages under standard environmental conditions(22° C.; 12/12 light/dark cycle; lights on at 7:00 A.M.) for 7-10 daysprior to surgery. Food and water were provided ad libitum. Animal careprocedures were conducted in accordance with the NIH Guidelines for theCare and Use of Laboratory Animals (NIH Publication no. 80-23) revised1996 and the guidelines of the IUPUI Institutional Animal Care and UseCommittee.

Radio-Telemetry for Measuring Cardiovascular and Locomotor Responses:

Telemetry probes (Data Science International, St. Paul Minn.) weresurgically implanted into the abdomen of anaesthetize rats to measurelocomotor responses. Cardiovascular responses were measured by a femoralarterial line connected to the telemetric probe which contained apressure transducer (Data Science International, St. Paul Minn.).

Inducing Panic Prone State in Rats:

After 3 days of recovery from telemetric probe surgery, cannulae(Plastics One Inc., Ranoake Va.) were directed at cardioexcitatoryregions of the dorsomedial/periformical hypothalamus (DMH/PeF) which wasconnected, via PE-60 tubing, to an osmotic minipump (DURECT Corporation)filled with 1-AG solution (a glutamic acid decarboxylase inhibitor) orwhen applicable d-allylglycine (d-AG: the inactive isomer of 1-AG). Theminipump was then sutured into place subcutaneously at the nape of theneck. The concentration of the solutions was such that 3.5 nmol/0.51 perhour of 1-AG or d-AG was infused continuously into the DMH/PeF regionfor the remainder of the given experiment. In the case of the siRNAexperiments specialized T-cannulae were implanted permitting access to aremovable 28 g injector to direct siRNA injections to the same locationas the 1-AG infusions. Additionally these rats had guide cannulaedirected to the opposite DMH/PeF for bilateral infusion of siRNA.

Description of hypertonic sodium lactate (NaLac) or Isotonic SalineInfusion:

Rats received intravenous (i.v.) infusions (10 ml over 15 min of either0.5M NaLac or 0.9% isotonic saline (when applicable)) using a syringepump at least five days following the initiation of 1-AG or d-AGinfusions. Once a stable baseline was achieved, i.v. infusions began andcardiovascular and activity data were recorded for 15 min (similar toclinical NaLac infusions).

Surgical Procedures and Osmotic Minipump Infusions:

Prior to and during surgery, rats were anesthetized with a nose coneconnected to an isoflurane system (MGX Research Machine; Vetamic,Rossville Ind.). Rats were fitted with femoral arterial catheters formeasurement of mean arterial blood pressure (MAP) and heart rate (HR)and with venous catheters for i.v. infusions.

Cardiovascular responses (i.e., MAP and HR) were measured by a femoralarterial line connected to a telemetric probe which contained a pressuretransducer (Cat. no. C50-PXT, Data Science International (DSI) St. PaulMinn.). DSI DATAQUEST software was used to monitor and record MAP andHR. MAP and HR were recorded continuously in freely moving consciousrats and are expressed as a 20 min time course. The data reported arechanges in HR and MAP from the average of the baseline (t−5 to t−1) fromeach rat.

After 3 days of recovery, animals were tested for baselinecardiovascular responses to lactate. Following baseline testing, ratswere anesthetized 26 gauge T-shaped cannulae (Cat. no. 3260PG, PlasticsOne Inc., Ranoake Va.) were directed at cardioexcitatory regions of thedorsomedial/periformical hypothalamus (DMH/PeF, see reference 2) basedon the following coordinates (from bregma: 1.2 mm posterior, +2.1 mmlateral, +9.1 mm ventral and adjusted for approaching at a 10 degreeangle toward the midline with the stereotaxic incisor bar elevated 5 mmabove the interaural line). The 26 gauge vertical arm of the T-shapedcannula was used for BMI injections while a 22 gauge side arm wasattached, via PE-60 tubing, to an osmotic minipump for 1-AG or d-AGinfusions (DURECT Corporation, Model no. 2002). Once the cannula wasplaced at the coordinates targeting the DMH/PeF, 50 pmol/100 nl of theGABAA receptor antagonist BMI was injected through the 22 gauge verticalarm of the guide cannula using a 33 gauge injection needle (cat. no.C315I, Plastics One Inc.) to ascertain that the tip of the cannula wasplaced in a cardioexcitatory region (i.e., where BMI elicits ≧50beats/min in HR). This microinjection protocol commenced only after astable baseline HR and MAP had been established for ˜10 min. Followingthe injection, the guide cannulae were retracted; filled with either the1-AG or d-AG solution; and cemented into place after being redirected tothe previous stereotaxic coordinates. The minipump was attached to thecannula assembly with PE-60 tubing filled with either the 1-AG or d-AGsolution; sutured into place subcutaneously at the nape of the neck. Theconcentration of the solutions was such that 3.5 nmol/0.5 μl per hour of1-AG or d-AG was infused continuously into the DMH region for theremainder of the given experiment.

Social Interaction Test:

The social interaction (SI) test is a fully validated test ofexperimental anxiety-like behavior in rats. The apparatus itselfconsists of a solid wooden box with an open roof approximately 0.9 mlong×0.9 m wide with walls 0.3 m high. All behavioral tests arevideotaped with a camera above the box. The “experimental” rat and anunfamiliar “partner” rat are both allowed to individually habituate tothe box for a 5 min period 24 h prior to each SI test. During the SItest, the two rats are placed together in the center of the box, and thetotal duration (sec) of non-aggressive physical contact (grooming,sniffing, crawling over and under, etc.) initiated by the “experimental”rat is quantified over a 5 min duration. A baseline SI test wasperformed 72+ h after i.v. catheterization, but prior to osmoticminipump implantation. Another SI test was performed 5 days followingminipump infusions and immediately following saline or sodium lactateinfusions. Videotaped sessions were scored at a later time by aresearcher blinded to any drug treatment.

Open-Field Behavior Test:

The open-field arena covered an area of 0.9 m×0.9 m, with 0.4 m highwalls. The open-field arena was divided into a 6×6 grid of equally-sizedsquares using black tape (36 total squares) with 4 squares forming thecentre; 12 squares forming the middle perimeter; and 20 squares formingthe outer perimeter. The test started by placing a rat in the centre.The behavior of each rat in the open-field arena was recorded on videoand scored afterwards by an observer blind to the experimental treatmentof each rat. Time spent in each region of the open-field was recorded.

Unconditioned Acoustic Startle Reflex Test:

Rats were placed into the startle chamber (35.6 cm wide×27.6 cm deep and49.7 cm high; model no. SM100SP, Hamilton Kinder, Poway, Calif.) andinitially they received a 5-min acclimation period. Following theacclimation period, rats were presented with 30 startle-eliciting sounds(10 each at 90, 95 and 105 db) with a 30 sec interval between noisebursts (onset and offset of startle eliciting sounds are programmed andexecuted using Startle Monitor Windows NT/2000/XP Platform basedsoftware). The vendor reports that this system has an accurate noisestimulus that uses a high precision circuit providing +/−1 dB accuracyat all points of the scale (57-120 dB) and from chamber to chamber. Thepresentation of the different startle-eliciting sounds were grouped intothree noises per bin and within each bin the order is randomized, sothat at the end of the first phase the animals have been exposed to 10bins for a total of 30 noise bursts given in a random but equallybalanced set. Response performance was measured with a Piezo transducercalibrated and reported in newtons +/−1% full scale (Rat insert andsensing plate, model no. SM2002, Hamilton Kinder).

Defensive Burying Test

The defensive burying test is a validated test of experimental anxietyand defensive-like behavior in rats. For four consecutive days beforedefensive burying test (days 3, 4, 5 and 6 post 1-AG onset), rats wereacclimated to the testing apparatus by placing them for 10 min in thetesting cage (a polycarbonate rat housing cage, 30.5 cm width×30.5 cmheight×61 cm length) with 2.5 cm of bedding covering the floor and asmall hole centered on a short dimension of the cage 2.5 cm above thebedding to accommodate the deactivated shock probe. The shock probe was1 cm in diameter and extended 6 cm into the cage. Along the entirelength of the exposed probe, 2 un-insulated wires were wrapped inparallel (not touching) so that the rat could not touch the probewithout getting a shock. On testing day 7 post 1-AG onset), theun-insulated wires of the prod were connected to a LaFayette precisionshock source (LaFayette Instruments Co., Model 5806). The shockintensity was set at 0.7 mA for the entire duration of testing so thatthe rat received a shock whenever the prod was contacted with itsforepaws or snout. Immediately following the offset of an i.v. infusion,rats were placed individually in the test cage away from the shock probe(near short dimension side of cage that did not have probe) and 10 minsessions were videotaped for later assessment of defensive buryingbehavior. Time spent burying, in proximity of probe, grooming (30.5 cmwidth×61 cm length cage was divided into two 30.5×30.5 areas; one nearprobe and one distal from probe) and freezing as well as number ofcenter line crossings were assessed. Behavioral assessments were madeusing software (ODLog Macropod Software for Windows, version 2.5.2) withdifferent keystrokes coupled to each defensive behavior to accuratelymeasure incidence and duration of each. The repertoire of behavioralreactions during a defensive burying test is well delineated andcatalogued in rats. These behaviors include: 1) burying behavior,defined as duration spent pushing, shoveling, flicking and diggingsawdust towards and around the prod with rapid movements of the snoutand forepaws; 2) Freezing, defined as immobility with the bodymotionless; 3) probe exploration, defined as time spent on half of cagewith probe; 4) rearing, defined as raising the body on the hind limbs ina vertical position; 5) ambulations, defined as number of times ratcrossed from side of cage with probe to other; and also 5) grooming,defined as face washing, scratching, tail biting and licking of thebody.

Example Experiment 2 c-Fos Induction in ORX Neurons of 1-AG and d-AGTreated Rats Following Infusions of NaLac or Saline

Immunohistochemistry

Perfusion:

Methods for perfusion and for verification of cannulae placements inexperiment 12 were performed following procedures discussed herein.Briefly, 1-AG or d-AG treated rats received i.v. infusions of eitherlactate or saline vehicle over 15 min (n=6/group for 4 groups), wereimmediately tested in the SI test, then anesthetized and perfused with a4% paraformaldehyde/1.5% sucrose solution and processed forimmunohistochemistry 90 min following the onset of the i.v. infusions.

Double Immunohistochemistry:

In the present study, two of the six alternate sets of 30 μm coronalhypothalamic sections were stained for c-Fos protein (rabbitanti-c-Fos-polyclonal, affinity-purified antibody, cat. no. PC38, Ab-5,Calbiochem; diluted 1:10,000) on day one and then either ORX (rabbitanti-orexin A-polyclonal, affinity-purified antibody, cat. no. PC345,Calbiochem; diluted 1:200) or melanin concentrating hormone (MCH: rabbitanti-MCH antiserum protein, cat. no. H-070-47, Phoenix Pharm. Inc.;diluted 1:2000) the following day. Brain sections from all rats wereimmunostained with the appropriate primary antibody in a singleimmunohistochemical run, rather than in batches, with large volumeincubations to limit variability in the quality of immunohistochemicalstaining among brain sections.

Sections were washed in PBS and then incubated in 1% H₂O₂ in PBS for 20min. Sections were washed in PBS then PBST then incubated 12-16 h inPBST with primary antibody. The following day, sections were incubated 2h in the appropriate secondary antibody: biotinylated swine anti-rabbitIgG (c-Fos day 1, and orexin A or MCH day 2; cat no. E0353; DAKO,diluted 1:200). Sections were washed again for 30 min in PBST thenincubated 1.5 h in an avidin-biotin-peroxidase complex (cat no. PK-6100,Vector Labs, diluted 1:200). Substrates for chromogen reactions were SG(c-Fos; cat. no. SK-4700, Vector Labs) or 0.01% 3,3′-diaminobenzidinetetrahydrochloride (ORXA or MCH, cat. no. D-5637, Sigma) in PBScontaining 0.003% H₂O₂, pH 7.4. Substrate reactions were run for 20 minfor all reactions. Brain sections were then mounted, dehydrated andcoverslipped for later analyses.

Within the DMH, but not LH, only panic-prone rats had increased cellularresponses in ORX (FIGS. 2-3; 1-AG effect, F_((1,20))=14.6, P=0.001), butnot MCH neurons ipsilateral to the minipump, and these ORX, but not MCHresponses, were correlated with changes in anxiety-related behavior.There was also an increase in the total number of ORX neurons in the LHcontralateral to the 1-AG infusion when comparing d-AG/saline and1-AG/saline treated rats (FIG. 2; 1-AG effect, F_((1,20))=7.4, p=0.013).Overall, these data are consistent with the hypothesis that removingGABAergic tone in the DMH alters local ORX neuronal activity to produceanxious rats that are prone to panic following lactate challenge.

Orexin A (ORX-A) producing neurons in the dorsomedial/periformicalhypothalamus (DMH/PeF) display increased c-Fos immunoreactive (ir)neurons selectively in panic-prone (1-AG treated), but not control (d-AGtreated), rats (n=6/group) (FIG. 2). 1-AG or d-AG treated rats receivedNaLac or saline challenge (n=6/group for 4 groups) as described aboveand were immediately tested in the social interaction (SI) test. 90 minfollowing the SI test rats were perfused and brains were immunoprocessedinto 6 parallel sets of coronal section (30 μm).

Example Experiment 3. Injections of siORX or siCON into the DMH/LHPanic-Prone Rats Prior to Sodium Lactate or Saline Challenge or inSeparate Control Rats

In experiment 3, an RNAase free environment was maintained throughoutthe injection procedure and all injectors, syringes and tubing wereexposed to RNaseZAP and rinsed thoroughly with RNA-free water prior tosiRNA injections. A set of control rats were: anesthetized withIsoflurane® and received stereotaxic injections of OnTargetPlusSmartPool® siRNA against rat ppORX gene (siORX, 100 nMol, Dharmacon,cat. no. L-091285-00, Rat HCRT, NM_(—)013179) into one side of theDMH/PeF, and negative control siRNA (siCON, 100 nMol, Dharmacon) intothe other side of DMH/PeF (the side of each injection wascounterbalanced) to confirm gene silencing; then sacrificed by rapiddecapitation, following a brief (30 s) exposure to IsoFlurane® and 48 hafter the siRNA injections. Rats with 1-AG minipumps and telemetricprobes had siORX or siCON injected bilaterally through guide canulaeopposite the 1-AG injector and through the minipump canulae ipislateralto 1-AG infusion. 48 hrs after siORX or siCON treatment, these rats wereexposed to saline or NaLac infusions (siCon/Sal n=4, siORX/Sal n=6,siCON/Lac n=5, siORX/Lac n=6) and SI behavioral and cardiovascularresponses were recorded, and were then sacrificed by rapid decapitation,following a brief (30 s) exposure to IsoFlurane® 1 hr after theintravenous infusions.

RNA Isolation, Reverse Transcription and Quantitative Real-Time PCR.

Total RNA from DMH/PeF and LH dissected tissue was isolated using RNeasymicro kit (Qiagen). Extracted RNA was then reverse transcribed using theGeneAmp Gold RNA PCR kit (Applied Biosystems) at the following reactionconditions: 2.5 μM Oligo-dT primer, 2.5 mM magnesium, 250 mM of eachdeoxynucleotide triphosphate, 0.5 μ/ml of RNase inhibitor and finalconcentration of 0.75 U/μl of MuLV reverse transcriptase. The reversetranscription conditions were 10 min at room temperature, 15 min at 42°C., 10 min at 68° C. and 5 min at 95° C. and produced approximately 25μl of product.

Beta-actin was used as a control for relative quantification. Allsamples were analyzed in triplicate for each gene. The PCR conditionswere 1.5 mM Mg⁺², 0.5 mM of each primer, 0.2 mM of deoxynucleotidetriphosphates using the SYBR Green kit (Applied Biosystems). PCR cyclingconditions were 50° C. for 2 min, 95° C. for 10 min and 40 cycles of 95°C. for 30 s, 65° C. for 30 s, and 72° C. for 1 min on an ABI 7700instrument. The uniformity of the PCR products was determined bydissociation curve analysis (Applied Biosystems) at the end of PCR.

RT-Q-PCR Quantification:

Standard curves of copy numbers based on size and absorbance at A260were developed for each gene. Each unknown sample was extrapolated fromthese standard curves. Relative expression of the gene of interest inthe samples is expressed as a ratio of copy number to beta-actin genecopy number.

TABLE 1 Gene, GI number, Forward primer 5′ to 3′, Reverse primer 5′to 3′ and product sizefor prepro-orexin; pro-dynorphin; pro-opiomelanocortin (POMC) and beta-actin (b-actin).product Gene GI number Forward primer 5′ to 3′ Reverse primer 5′ to 3′size Prepro-orexin NM_013179 TCTCTACGAACTGTTGCACGGACTAAAGCGGTGGCGGTTGCAGT 227 Pro-dynorphin NM_019374TCCATTTCAACGAGGAGGACTTGA TGACGCCGCAGAAAACCACCATA 233 POMC NM_139326CTGTGAAGGTGTACCCCAATGTC ATGGCGTTCTTGAAGAGCGTCAC 250 b-actin NM_031144TATGTTGCCCTAGACTTCGAGCAA ACGGATGTCAACGTCACACTTCAT 219

AG or 1-AG infusions correlated with changes in the duration of SI frombaseline to post allylglycine infusions. In experiment 3, prior (48 h)injections of small interfering (si) RNA targeting prepro-orexin mRNA(siORX), but not control siRNA (siCON), into the DMH/PeF of panic-pronerats (1-AG treated) attenuated 1-AG-induced (FIG. 3) anxiety-likeresponses (social interaction (SI) duration, n=5, 6, 5, 6; time×siRNAeffect F(1,18)=5.2, p=0.035, * indicate Tukey's test and † indicatespaired 2 tailed t-test, p<0.05) and 1-AG+lactate induced increases in(FIG. 4) general locomotor activity (increase over time F(4,20)=4.1,p=0.014 in only 1-AG+siCON+Vehicle group when assessing t−5 m to t+7.5m), (FIG. 5) heart rate ((HR) increase over time in only thesiCON+lactate group (F(19,80)=4.6, p=0.001) with time×siRNA(F(19,323)=2.3, p=0.002) and time×i.v. infusion (F(19,323)=2.9, p=0.001)interactions between groups) and (FIG. 6) mean arterial blood pressure((MAP) increase over time F(19,80)=6.3, p=0.001 in only thesiCON+lactate group with time×siRNA (F(19,323)=2.2, p=0.003) andtime×i.v. infusion (F(19,323)=5.5, p=0.001) interactions betweengroups). For cardiovascular data, * (Dunnett's test) and a and b(Tukey's tests) indicate p<0.05.

Tissue Preparation and Micropunch for RT-PCR

All equipment and working surfaces were kept RNase free duringdissection of the regions of interest. Frozen brains were sliced throughthe hypothalamus at 300 μm (coronal), using a Leica cryostat, and sliceswere placed onto microscope slides. Locations of injectors were verifiedin the slices using a Leica dissecting microscope set to 4×magnification. The DMH/PeF and lateral hypothalamus (LH) were dissectedout of 2 adjacent 300 μm coronal brain slices using Microtome tissuemicropunch (inside diameter=1.22 mm) at each location (bilateral DMH/PeFand LH). The DMH/PeF and LH tissue were immediately placed into 75 μl ofRNAlater (Qiagen) and samples were placed on dry ice and kept at −80° C.overnight. Total RNA from DMH/PeF and LH dissected tissue was isolatedusing RNeasy micro kit (Qiagen). Extracted RNA was then reversetranscribed using the GeneAmp Gold RNA PCR kit (Applied Biosystems) atthe following reaction conditions: 2.5 μM Oligo-dT primer, 2.5 mMmagnesium, 250 mM of each deoxynucleotide triphosphate, 0.5 μ/ml ofRNase inhibitor and final concentration of 0.75 U/μl of MuLV reversetranscriptase. The reverse transcription conditions were 10 min at roomtemperature, 15 min at 42° C., 10 min at 68° C. and 5 min at 95° C. andproduced approximately 25 μl of product.

The PCR conditions for both ppORX and beta-actin (endogenous control)were 1.5 mM Mg+2, 0.5 mM of each primer, 0.2 mM of deoxynucleotidetriphosphates using the SYBR Green kit (Applied Biosystems). PCR cyclingconditions were 50° C. for 2 min, 95° C. for 10 min and 40 cycles of 95°C. for 30 s, 65° C. for 30 s, and 72° C. for 1 min on an ABI 7700instrument. The uniformity of the PCR products was determined bydissociation curve analysis (Applied Biosystems) at the end of PCR. Allsamples were analyzed in triplicate. Standard curves of copy numbersbased on size and absorbance at A260 were developed for each gene. Eachunknown sample was extrapolated from these standard curves. Relativeexpression of the gene of interest in the samples is expressed as aratio of copy number to beta-actin gene copy number.

Coronal illustration of unilateral 1-AG infusions (verified prior tomicropunches) and bilateral siORX or siCON injections, and micropunchestaken for later mRNA assays; 1) Injecting siORX into the DMH/PeF ofcontrol rats reduced concentrations of local prepro-ORX (ppORX) mRNA inthe combined DMH/LH (* compared to siCON group injected on contralateralside, t(8)=1.9, p=0.047). Bilateral injections of siORX, but not siCON,into the DMH/PeF of panic-prone rats challenged with saline reducedlocal concentrations of (FIG. 7) ppORX (siRNA effect F(1,18)=6.0,p=0.025), but not (FIG. 8) pro-dynorphin (pDyn, siRNA effectF(1,11)=1.8, p=0.184,) or (FIG. 9) pro-opiomelanocortin (POMC, siRNAeffect F(1,11)=1.8, p=0.207) mRNA in the DMH/LH. Challenging panic-pronerats (siCON or siORX treated) with lactate decreased m) local ppORX(i.v. infusion×siRNA interaction F(1,18)=9.1, p=0.007) and n) pDyn mRNA(i.v. infusion effect F(1,11)=23.7, p=0.001) and o) increased POMC (i.v.infusion effect F(1,11)=9.2, p=0.012) mRNA (* indicate p<0.05, comparedto siCON+Sal group by Tukey's test). The last bar in FIGS. 7-9represents the concentration of mRNA in the DMH/LH of untreated homecagecontrol rats. All mRNA levels were determined by absolute quantitativeRT-PCR and are expressed relative to absolute beta-actin mRNA levels.Abbreviations: contra, contralateral; DA, dorsal hypothalamic area; DMH,dorsomedial hypothalamus; ipsi, ipsilateral; LH, lateral hypothalamus.

Example Experiment 4. Pre-Treatment with Orexin Receptor Antagonist orAlprazolam on NaLac Induced Behaviors

Systemically injecting the ORX1 receptor antagonist (SB334867) orbenzodiazepine (alprazolam) into panic-prone rats prior to NaLacchallenges attenuated (FIG. 10) anxiety-like responses (socialinteraction (SI) duration; n=12, 8, 11, 12, 6; treatment effectF(4,44)=17.1, p=0.001) and NaLac induced increases in (FIG. 11) generallocomotor activity (n=10, 6, 10; treatment×time effect F(14,161)=2.0,p=0.017), (FIG. 12) heart rate (HR, n=12, 6, 11; drug×time effectF(38,494)=3.9, p=0.001), (FIG. 13) mean arterial blood pressure (MAP,n=12, 6, 10; drug×time effect F(38,475)=2.7, p=0.001). Similarly inexperiment 5, systemically injecting SB334867 into panic-prone ratsprior to NaLac challenges attenuated (FIG. 14) anxiety-like responses(decreased time spent in center of open field; n=8, 4, 6; one outlierdetected in veh NaLac treated rats (Grubb's test, z value=1.89, p<0.05),treatment effect, Levene's test for homogeneity revealed unequalvariance, F(2,15)=9.6, p=0.002 so a nonparametric a Kruskal-WallisANOVA/Mann-whitney U-test was F(2)=7.4, p=0.025) and NaLac inducedincreases in (FIG. 17) mean arterial blood pressure (MAP, n=5, 5;drug×time effect F(19,152)=2.7, p=0.001), and (FIG. 16) heart rate (HR,n=5, 5; drug×time effect F(19,152)=0.6, p=0.873). (FIG. 15) No changewas detected in general locomotor activity (n=5, 5; drug×time effectF(7,56)=0.9, p=0.480). In experiment 6, systemically injecting a 2ndORX1 receptor antagonist (SB408124) into panic-prone rats did notsignificantly alter (FIG. 18) the SI duration, or (FIG. 21) MAP, but didattenuate NaLac induced increases in (FIG. 19) locomotor activity (n=4,drug×time effect, F(7,42)=3.6, p=0.004) and m) HR (n=4/group, drug×timeeffect, F(19,114)=3.7, p=0.001). For anxiety tests in FIGS. 3, 10, and18, * and + indicate significant differences between groups using aTukey's HSD tests with p<0.05. For activity and cardiovascular data, *indicates significantly different from baseline using a Dunnett's test,† indicates significantly different using a paired t-tests for SB334867in FIGS. 15-17 and SB408124 in FIGS. 19-21, and † and # indicatesignificant differences between groups using a Tukey's HSD tests forSB334867 in FIGS. 11-13 with p<0.05. Except for activity data in FIG. 15(t(4)=−2.9, p=0.043), there was no significant baseline HR, MAP oractivity between groups. Correct probe-placements were verified.

As shown in FIG. 22, experiment 8, assessment of defensive shock (DS)associated behaviors revealed that, compared to saline infused controls,1-AG+NaLac+Vehicle (Veh) treated rats a) spent over half of the 5 min DStest immobile or “freezing” (F(2,6)=7.9, p=0.021), which was completelyblocked in the 1-AG+NaLac group systemically treated with the SB334867(SB33) ORX1 receptor antagonist (see FIG. 22 a). Defensive shock testcage is illustrated in inset in FIG. 22 a. An interesting finding wasthat, compared to the 1-AG+NaLac rats injected with SB334867, the1-AG+sal and 1-AG+NaLac rats treated with vehicle spent little to notime burying during the test (F(2,6)=12.1, p=0.008). No differences weredetected in time spent near probe (F(2,6)=2.3, p=0.182), rearing(F(2,6)=1.2, p=0.360), or grooming (F(2,6)=3.1, p=0.112) or (FIG. 22 b)number of times crossed line dividing halves of test cage (i.e., probeside versus non-probe side (F(2,6)=1.3, p=0.344)). (FIG. 22 c)Unilateral injections of the ORX1 receptor antagonist SB334867 (300pmoles/100 nl) into the bed nucleus of the stria terminalis (BNST) of1-AG treated rats prior to the lactate challenge restored the durationof SI to normal baseline levels, compared to SI duration followingvehicle injection (t(4)=6.9, p=0.0002, n=5/crossover design: experiment9). Bars in graphs represent the mean, and error bars represent thestandard error of the mean. Infusion placements in DMH/PeF andinjections sites into the BNST were verified.

Example Experiments 5-7. Attenuating Panic-Like Responses with SystemicORX1 Receptor Antagonists

In experiments 4-6, rats were made panic vulnerable with 1-AG. 5 daysafter 1-AG onset, in a counterbalanced design, rats receivedintraperitoneal (i.p.) injections of treatment drug or vehicle 30 minprior to i.v. infusions. In experiment 4, rats were injected with theORX1 receptor antagonist SB334867(N-(2-Methyl-6-benzoxazolyl)-N′-1,5-naphthyridin-4-yl urea) (30 mg/kg,Tocris, in 0.2 ml/100 g volume DMSO, n=12), alprazolam (3 mg/kg, Sigma,in 0.2 ml/100 g volume DMSO, n=6) or vehicle (0.2 ml/100 g volume DMSO,n=11) 30 min prior to a NaLac challenge and, immediately after, a SItest was used to assess anxiety behavior. In experiment 5, baseline inan open field (OF) behavior test of anxiety was assessed (n=8) prior to1-AG infusions. 5 days after 1-AG treatment, rats were split into 3treatment groups, where groups received: i.p. vehicle+i.v. saline (n=5);i.p. vehicle+i.v. NaLac (n=5); or i.p. SB334867 (30 mg/kg)+i.v. NaLac(n=6). Immediately following the NaLac challenge, rats were placed inthe OF test. 72 h later, this was repeated except that each rat receivedan alternative treatment, so that all rats received 2 of the 3treatments (i.e., vehicle/saline and vehicle/NaLac; vehicle/NaLac andSB334867/NaLac; or vehicle/saline and SB334867/NaLac). In experiment6,1-AG treated rats received an injection of an alternative ORX1receptor antagonist (30 mg/kg SB408124(N-(6,8-Difluoro-2-methyl-4-quinolinyl)-N′-(4-(dimethylamino)phenyl)urea),Tocris, in 0.2 ml/100 g volume DMSO, n=4) or vehicle (0.2 ml/100 gvolume DMSO, n=6) 30 min prior to NaLac. In experiment 7, control rats(no 1-AG or NaLac treatment) were assessed in a SI test. 48 h laterthese rats received an i.p. injection of an ORX1 receptor antagonist (30mg/kg SB334867, Tocris, in 0.2 ml/100 g volume DMSO, n=7) or vehicle(0.2 ml/100 g volume DMSO, n=7) and 30 min post injection cardiovascularactivity was monitored for 20 min followed by an immediate SI test.

Example Systemic SB334867 or Alprazolam in Panic-Prone Rats Prior toLactate Challenge Using Social Interaction to Assess Anxiety Behavior

Adult male Sprague-Dawley rats were anesthetized and surgicallyimplanted with telemetrical probes to measure cardiovascular activityprior to and during lactate infusions. After a 3 day recovery, rats wereanaesthetized and had osmotic minipumps (previously filled with 1-AG)stereotaxically implanted unilaterally into the DMH. 5 days later, in acounterbalanced design, half of these rats received an intraperitoneal(i.p.) injection of the ORX1R antagonist, SB334867 [30 mg/kg, cat. no.1960, Tocris, in 0.2 ml/100 g volume DMSO, n=12], alprazolam (3 mg/kg,Sigma, in 0.2 ml/100 g volume DMSO, n=6) or vehicle (0.2 ml/100 g volumeDMSO, n=11) 30 min prior lactate challenge.

Prior i.p. injections of SB334867 and alprazolam, but not vehicle,attenuated all lactate induced panic-like responses in panic-prone (1-AGtreated) rats [SI (n=14, 8, 11, 12, 6, drug effect F_((4,36))=17.8,p=0.001); Activity (n=10, 6, 10, drug×time F_((14,161))=2.0, p=0.017),HR (n=12, 6, 11, drug×time F_((38,494))=3.9, p=0.001); and MAP (n=12, 6,10, drug×time F_((38,475))=2.7, p=0.001) (see FIG. 10-13]. Histologyverified that all minipump cannulae were in the DMH/PeF region. Baselineanalyses [Activity, F_((2,23))=2.5, p=0.101; MAP, F_((2,24))=0.9,p=0.435; HR, F_((2,26))=6.3, p=0.006, SB334867 and alprazolam baselinesdiffered, but neither SB not alprazolam baselines differed betweenvehicle controls using Tukey's HSD posthoc].

Example Systemic SB334867 in Panic-Prone Rats Prior to Lactate ChallengeUsing Open Field to Assess Anxiety Behavior

All adult male Sprague-Dawley rats were anesthetized and surgicallyimplanted with telemetrical probes to measure cardiovascular activityprior to and during lactate infusions. After a 3 day recovery, baselineopen field behavior was assessed (n=8), then rats were anaesthetized andhad osmotic minipumps (previously filled with 1-AG) stereotaxicallyimplanted unilaterally into the DMH. 5 days later rats were split into 3treatment groups (n=5/group), where each group received a priorintraperitoneal (i.p.) injection of the ORX1R antagonist, SB334867 [30mg/kg, cat. no. 1960, Tocris, in 0.2 ml/100 g volume DMSO, n=6], orvehicle (0.2 ml/100 g volume DMSO, n=5) 30 min prior lactate.Immediately following the lactate challenge, the rats were assessed foranxiety using the open field test. Seventy two hours later, this wasrepeated except that each rats received an alternative treatment, sothat all rats received 2 of the 3 treatments (i.e., Sal/Vehicle andNaLac/Veh; NaLac/Veh and NaLac/SB334867; or Sal/Veh and NaLac/SB334867).

Systemically injecting SB334867 i.p. into panic-prone rats prior toNaLac challenges attenuated anxiety-like responses [FIG. 14, decreasedtime spent in center of open field; n=8, 4, 6; one outlier detected inveh NaLac treated rats (Grubb's test, z value=1.89, p<0.05), treatmenteffect, Levene's test for homogeneity revealed unequal variance,F_((2,15))=9.6, p=0.002 so a nonparametric a Kruskal-WallisANOVA/Mann-whitney U-test was F₍₂₎=7.4, p=0.025) and NaLac inducedincreases in and heart rate (FIG. 16, HR, n=5, 5; drug×time effectF_((19,152))=0.6, p=0.873), and mean arterial blood pressure (FIG. 17,MAP, n=5, 5; drug×time effect F_((19,152))=2.7, p=0.001). No change wasdetected in general locomotor activity (FIG. 15, n=5, 5; drug×timeeffect F_((7,56))=0.9, p=0.480). Baseline analyses revealed significantdifference in activity (t₍₄₎=−2.9, p=0.043), but not for HR (t₍₄₎=−0.04,p=0.972) or MAP (t₍₄₎=−0.12, p=0.908). Histology verified that allminipump cannulae were in the DMH region.

Example Systemic SB408124 in Panic-Prone Rats Prior to Lactate Challenge

Adult male Sprague-Dawley rats were anesthetized and surgicallyimplanted with telemetrical probes to measure cardiovascular activity.After a 3 day recovery, rats were anaesthetized and had osmoticminipumps (previously filled with 1-AG) stereotaxically implantedunilaterally into the DMH. 5 days later, in a counterbalanced design,half of these rats received a prior intraperitoneal (i.p.) injection ofan ORX1 R antagonist [30 mg/kg SB408124, cat. no. 1963, Tocris, in 0.2ml/100 g volume DMSO, n=4] or vehicle (0.2 ml/100 g volume DMSO, n=6) 30min prior lactate challenge.

Prior i.p. injections of SB408124, but not vehicle, attenuated lactateinduced tachycardia responses in panic-prone (1-AG treated) rats [HR(drug×time F_((19,114))=3.7, p=0.001); MAP (drug×time F_((19,114))=0.9,p=0.629); SI (F_((3,20))=2.1, p=0.133) (see FIGS. 19-21)]. None of thebaseline analyses were significantly different between groups [Activity,t₍₃₎=−2.5, p=0.101; MAP, t₍₃₎=−1.1, p=0.345; HR, t₍₃₎=−0.3, p=0.804].Histology verified that all minipump cannulae were in the DMH region.

Example Systemic SB334867 on Baseline Behavior and CardiovascularActivity in Control Rats

Adult male Sprague-Dawley rats were anesthetized and surgicallyimplanted with telemetrical probes to measure cardiovascular activityprior to and during lactate infusions. After a 3 day recovery, in acounterbalanced design, half of these rats received a priorintraperitoneal (i.p.) injection of an ORX1R antagonist [30 mg/kgSB334867, cat. no. 1960, Tocris, in 0.2 ml/100 g volume DMSO, n=7] orvehicle (0.2 ml/100 g volume DMSO, n=7). Cardiovascular activity and SItests were monitored 30 min following injection at similar time points.

Administering same dose of SB334867 to control rats had no effect on HR(drug×time F_((19,228))=0.8, p=0.691), MAP (drug×timeF_((19,228))=0.001, p=0.974) or SI duration (F_((2,18))=0.5, p=0.604) 30min following injections (monitored for 20 min starting at the min postinjection time point).

Example Experiment 8. 1-AG and 1-AG+NaLac Effects on UnconditionedDefensive Burying-Associated Behaviors

On day 1 adult male Sprague-Dawley rats (n=3/group) were anaesthetizedand had osmotic minipumps (previously filled with 1-AG) stereotaxicallyimplanted unilaterally into the DMH/PeF. Prior to testing, rats eitherreceived an i.p. injection of the ORX1R antagonist, SB334867 [30 mg/kg,cat. no. 1960, Tocris, in 0.2 ml/100 g volume DMSO, n=3], or vehicle(0.2 ml/100 g volume DMSO, n=6) 30 min prior challenge infusion. TheSB334867+1-AG group of rats (n=3) and 3 of the vehicle+1-AG rats weregiven an i.v. infusion of NaLac, whereas the remaining vehicle+1-AGgroup were infused with saline. Immediately following the offset of thei.v. infusion, rats were placed individually in the test cage away fromthe shock probe (near short dimension side of cage that did not haveprobe) and 10 min sessions were videotaped for later assessment ofdefensive burying behavior. Time spent burying, in proximity of probe,grooming (30.5 cm width×61 cm length cage was divided into two 30.5×30.5areas; one near probe and one distal from probe) and freezing as well asnumber of center line crossings were assessed. Behavioral assessmentswere made using software (ODLog Macropod Software for Windows, version2.5.2) with different keystrokes coupled to each defensive behavior toaccurately measure incidence and duration of each.

All rats received explored the probe and received a shock (verified bycontact with probe+startle response) within 45 sec of 5 min test.Assessment of defensive burying associated behaviors revealed that,compared to saline infused controls, 1-AG+NaLac+Veh treated rats spentover half of the 5 min DB test immobile or “freezing” (F_((2,6))=7.9,p=0.002), which was completely blocked in the 1-AG+NaLac group treatedwith the SB334867 compound (see FIG. 22 a). An interesting finding wasthat, compared to the 1-AG+NaLac rats injected with SB334867, the1-AG+sal and 1-AG+NaLac rats treated with vehicle spent little to notime burying during the test (F_((2,6))=12.1, p=0.008). No differenceswere detected in time spent near probe (F_((2,6))=2.3, p=0.182), rearing(F_((2,6))=1.2, p=0.360), or grooming (F_((2,6))=3.1, p=0.112).

Example Experiment 9. ORX1 Receptor Antagonist into the Bed Nucleus ofthe Stria Terminalis (BNST) of 1-AG+NaLac-Treated Rats

Rats (n=5/group in a crossover design) were treated with 1-AG into theDMH/PeF and 5 days postpump received unilateral injections of SB334867(300 pmoles/100 nl of DMSO vehicle) or DMSO vehicle directed at the BNST[using a 33 gauge injector (ck no. C315I, Plastics One), which extended1 mm past the 24 gauge cannula (cat. no. C315G, Plastics One)] 30 minprior to receiving i.v. infusions of 0.5 M sodium lactate. Stereotaxiccoordinates relative to bregma for the BNST, using a 10° angle from thevertical plane with the incisor bar set at +5 mm were: Anterior +1.0 mm,Lateral +2.5 mm and Ventral −7.0 mm. An SI test was conductedimmediately following the offset of the lactate challenge. 48 h wasallowed between randomized injections.

Unilateral injections of an ORX1 receptor antagonist (i.e., SB334867,300 pmoles/100 nl of DMSO vehicle) into the BNST of 1-AG treated ratsprior to the lactate challenge reduced the duration of SI as compared toDMSO vehicle injected rats (t₍₄₎=6.9, p=0.0002, n=5/crossover design,see FIG. 22 c). Infusion sites for 1-AG into the DMH/PeF and vehicle andSB334867 injection sites into the BNST were confirmed.

Example 1-AG Effects on Unconditioned Acoustic Example Experiment 10.1-AG Effects on Unconditioned Acoustic Startle

In experiment 10, rats (n=8/group) were made panic vulnerable with 1-AG.An acoustic startle reflex was tested the day prior to receiving the1-AG pump surgeries and 5 days following the onset of the 1-AG pumpinfusions.

Adult male Sprague-Dawley rats (n=8/group) were anaesthetized and hadosmotic minipumps (previously filled with 1-AG) stereotaxicallyimplanted unilaterally into the DMH/PeF. An acoustic startle reflex wastested the day prior to receiving the 1-AG pump surgeries and 5 daysfollowing the onset of the I-AG pump infusions.

Unconditioned acoustic startle responses were not altered by 1-AGinfusions into the DMH/PeF when comparing responses prior to and after1-AG infusions (FIG. 23) [there was an increase in the acoustic startleresponse in both groups due to increases in decibel intensityF_((2,28))=29.8, p=0.001; but no overall I-AG effect F_((1,14))=0.1,p=0.810; or 1-AG×decibel intensity interaction F_((2,28))=0.01,p=0.993]. Histology verified that all minipump cannulae were in theDMH/PeF region. These results indicate that panic-like and anxiety-likeresponses elicited by infusions of 1-AG into the DMH is not due to anon-specific increase in arousal as there are no changes noted inbaseline unconditioned acoustic startle responses, a finding that isalso noted in subjects with panic disorder.

Example Experiment 11. Activation of Orexin System is a Component of CO₂Mediated Anxiety and Hypertension But Not Bradycardia

All experiments were conducted on adult male Sprague-Dawley rats(300-350 g) purchased from Harlan Laboratories (Indianapolis, Ind., USA)and were housed individually in plastic cages under standardenvironmental conditions (22° C.; 12/12 light/dark cycle; lights on at7:00 A.M.) for 7-10 days prior to the surgical manipulations. Food andwater were provided ad libitum. Animal care procedures were conducted inaccordance with the NIH Guidelines for the Care and Use of LaboratoryAnimals (NIH Publication no. 80-23) revised 1996 and the guidelines ofthe IUPUI Institutional Animal Care and Use Committee.

Prior to surgery, rats were anesthetised with a nose cone connected toan isoflurane system (MGX Research Machine; Vetamic, Rossville Ind.,USA) during the surgery. All rats were fitted with femoral arterialcatheters for measurement of mean arterial blood pressure (MAP) andheart rate (HR) as previously described (Shekhar et al., 1996). Briefly,cardiovascular responses were measured by a femoral arterial lineconnected to a telemetric probe that contained a pressure transducer[Cat. no. C50-PXT, Data Sciences International (DSI), St. Paul, Minn.,USA]. DSI dataquest software was used to monitor and record MAP and HR.For the duration of each experiment, MAP and HR were recordedcontinuously in freely moving conscious rats. Data were analyzed duringthe period 5 min prior to, 5 min during, and 5 min following the gaschallenges. The data reported are changes in HR and MAP, expressed in 1min bins, relative to the average of the baseline measurement (t−5 minto t−1 min) from each rat.

Flow cages (12 in. width×12 in. height×24 in. length) were custom builtusing Plexiglas®. When the lid of the cage was latched, gases could onlyenter the cage through an inlet connector (for the gas infusion) andcould only exit the cage through an outlet connector. The gas flow intothe cages was controlled using a 2-stage regulator (Praxair, Inc.,Danbury, Conn., USA) at a pressure of 0.6 Bar. The consistency of therate of CO₂ delivery was validated using state-of-the-art infrared CO₂(ProCO₂) and electrochemical O₂ (ProO₂) sensors in Experiment 12.

On day 1, rats (n=3/group) were selected from their home cages andplaced into experimental cages containing atmospheric air. All rats hadinfusions of the following: 1) 5 min infusion of premixed atmosphericgas (<1% CO₂, 21% O₂, 79% N₂: Praxair, Inc.) for baseline measurements,then 2) either the premixed atmospheric control gas (<1% CO₂, 21% O₂,79% N₂) or premixed experimental normoxic, hypercarbic gas (20% CO₂, 21%O₂, 59% N₂: Praxair) for 5 min (note: for control rats the atmosphericgas was turned off and back on again at the beginning and end of thisinfusion to be identical to the manipulations for the hypercarbic gaschallenge), and finally, 3) 5 min infusion of atmospheric gas. Fecalpellets were counted in cages at the end of gas challenges. In order toassess anxiety-like behavioural responses following exposure tohypercarbic gas, rats were immediately transferred to an adjacent roomand place in the center square of an open-field box for a 5 min test. Onday 2, the experiment was repeated, but the treatments were reversed foreach rat. For instance, rats that received atmospheric gas challenge onday 1 received the hypercapnic gas challenge on day 2.

The open-field arena covered an area of 90 cm×90 cm, with 40 cm highwalls. The open-field arena was divided into a 6×6 grid of equally-sizedsquares using black tape (36 total squares) with 4 squares forming thecenter; 12 squares forming the middle perimeter; and 20 squares formingthe outer perimeter. The test started by placing a rat in the center.The behavior of each rat in the open-field arena was recorded on videoand scored afterwards by an observer (PLJ) blind to the experimentaltreatment of each rat. Time spent in each region of the open-field wasrecorded. In addition, locomotor activity was assessed by counting thenumber of times the rat's entire body (excluding tail) completelycrossed into another square.

Infusion of premixed gases, either atmospheric air (<1% CO₂, 21% O₂, 79%N₂) or normoxic, hypercarbic gas (20% CO₂, 21% O₂, 59% N₂) (PraxairEspana, Madrid, Spain), began 1 min after placement of rats (n=7/group)in the cages and continued for 5 min. At that time the gas flow wasterminated and cages were opened to allow rapid equilibration withatmospheric air. Rats were left in the cages for an additional 5 min andthen were transferred to their original home cages.

Ninety min following the initiation of treatment, rats were anesthetizedwith an overdose of sodium pentobarbital (40 mg, i.p.) then perfusedtranscardially with 0.05 M phosphate buffered saline (PBS; 250 ml),followed by 0.1 M sodium phosphate buffer (PB; 250 ml) containing 4%paraformaldehyde (PFA) and 3% sucrose. Brains were removed andpost-fixed for 24 h in the same fixative, rinsed for 24 h in 0.1 M PB,then placed in cryoprotectant (30% sucrose in 0.1 M PB) for anadditional 4-5 days. To maintain a consistent plane for coronalsections, brains were placed in a rat brain matrix (ASI instruments,Model No. RBM-4000C, Warren Mich., USA) and cut with a razor blade atthe caudal border of the mammillary bodies. Brains were frozen in cooledliquid isopentane made by immersing a plastic vessel containingisopentane into a dewar flask containing liquid nitrogen. Serial coronalsections (30 μm) were cut using a cryostat and were immediately placedin cryoprotectant consisting of 27% ethylene glycol and 16% glycerol in0.05 M PB to yield six alternate sets of sections. Sections were storedat ˜20° C. until immunohistochemical processing. All solutions had a pHof 7.4.

Double immunostaining for c-Fos protein and ORX was accomplished withsequential immunohistochemical procedures using 1) primary antibodiesdirected against c-Fos (rabbit anti-c-Fos polyclonal antibody, Cat. no.sc-52, Ab-5, Santa Cruz Biotech., Santa Cruz, Calif., USA; diluted1:10,000) then 2) primary antibodies directed against ORX-A (rabbitanti-ORX-A-polyclonal, affinity-purified antibody, Cat. no. H-003-30,Phoenix Pharmaceuticals, Burlingame, Calif., USA; diluted 1:10,000). Allbrain sections were immunostained in a single immunohistochemical run,rather than in batches, with large volume incubations to limitvariability in the quality of immunohistochemical staining among brainsections.

Free-floating sections were washed in 0.05 M PBS for 30 min, thenincubated in 1% H₂O₂ in PBS for 20 min. Sections were then washed 10 minin PBS and 20 min in PBS with 0.3% Triton X-100 (PBST). Sections werethen incubated 12-16 hr in PBST with primary antibody solution at roomtemperature. After a 30 min wash in PBST, sections were incubated inbiotinylated goat anti-rabbit IgG (c-Fos, ORX-A; Cat .no. BA-1000;Vector Laboratories, Burlingame, Calif., USA; diluted 1:500). Sectionswere washed again for 30 min in PBST then incubated 1.5 hr in anavidin-biotin complex provided in a standard Vector Elite kit (c-Fos,ORX-A, Cat no. PK-6100, Vector Laboratories; diluted 1:500). Substratesfor chromogen reactions were SG (c-Fos; SK-4700, Vector Laboratories) or0.01% 3,3′-diaminobenzidine tetrahydrochloride (ORX-A; DAB) (Cat. no.D-5637, Sigma-Aldrich, Poole, UK) in PBS containing 0.003% H₂O₂, pH 7.4.Substrate reactions were run for 20 min for c-Fos and 10 min for ORX-A.All sections were mounted on clean glass slides, dried overnight,dehydrated and mounted with cover slips using DPX mounting medium (BDHLaboratory Supplies, Poole, U.K.). All washes and incubations were donein 12-well polystyrene plates with low frequency shaking on an orbitalshaker.

Selection of anatomical levels for analysis of c-Fos/ORX-A-immunostainedcells was conducted with reference to illustrations from a rat brainstereotaxic atlas (Paxinos and Watson, 1997). Selection of anatomicallevels was also done in reference to major anatomical landmarksincluding white matter tracts and the ventricular systems. Specifically,darkfield contrast [i.e., using a 1.6× Leica phase contrast Planobjective and Leica binocular microscope (model DMLB, Leica Mikroskopieand Systeme GmbH, Wetzler, Germany) with a darkfield condenser] was usedto visualise white matter tracts (e.g., the formix and optic tracts) andventricular systems (e.g., lateral, 3^(rd) ventricles) that aided inselection of appropriate coronal levels with reference to illustrationsin a standard stereotaxic atlas of the rat brain (Paxinos and Watson,1997). The numbers of c-Fos/ORX-A-ir neurons were counted in the entirefield of view at 400× magnification (i.e., 10× eyepiece and 40× Planobjective) for each brain region. The area of the DMH/PeF where singleORX-A-ir neurons and double c-Fos/ORX-ir neurons was counted was roughlysquare in dimension with the corners being the mammillothalamic tract,the formix, the top of the 3^(rd) ventricle and a point located halfwaydown the 3^(rd) ventricle (immediately medial from the formix). TheDMH/PeF, as described, is particularly sensitive to BMI-inducedcardioexcitatory response. All single ORX-A-ir neurons and doublec-Fos/ORX-ir neurons counted that were lateral to the DMH/PeF area wereconsidered to be in the LH region. All cell counts were done by anobserver that was blind to the experimental treatment of each animal.

Photomicrographs were obtained using a brightfield microscope using NPlan 5×, 10×, 40× and 63× objective lenses (Leica binocular microscope,model DMLB), an Insight digital camera (Diagnostics Instruments Inc.,Sterling Heights, Mich., USA) and SPOT 3.5.5 for Windows digital imagingsoftware (Silicon Graphics, Mountain View, Calif., USA). Photographicplates were prepared in CorelDraw 11.633 for Windows.

Infusion of hypercarbic, but not atmospheric, gas increased MAP (gasinfusion×time interaction, F_((14,56))=6.4, P=0.0001; gas infusioneffect, F_((1,4))=11.0, P=0.029; CO₂ group within group time effect,F_((14,30))=3.3, P=0.003, FIG. 24) and decreased HR (gas infusion×timeinteraction F_((14,56))=2.4, P=0.011; CO₂ group within group time effectF_((14,30))=3.1, P=0.005, FIG. 25) without altering locomotor activity(gas infusion×time interaction F_((1,4))=2.5, P=0.200). A 5 minatmospheric gas challenge did not alter MAP (FIG. 24), HR (FIG. 25) orlocomotor responses relative to the 5 min baseline. Rats exposed tohypercarbic gas also had increased numbers of fecal pellets postchallenge, compared to atmospheric gas challenged controls (t₍₂₎=−4.2,P=0.027, FIG. 26). No significant differences in baseline MAP, HR oractivity (over 5 min initial atmospheric gas exposure prior to challengewith experimental gases) were noted between treatment groups.

Open-Field Test

Compared to atmospheric gas-challenged rats, hypercarbic gas-challengedrats spent less time in the middle perimeter (thd (2)=5.4, P=0.016) andmore time in the outer perimeter (t₍₂₎=−3.5, P=0.036) of the open-field(FIG. 27). No difference was noted between groups for the time spent inthe center (t₍₂₎=1.0, P=0.211) of the open-field.

Example Experiment 12 Effects of Hypercarbic Gas on Hypothalamic ORXmRNA Expression

Adult male rats were housed as stated in the previous Example. On theday of the experiment, rats were placed in flow cages (12 in. width×12in. height×24 in. length) and infusion of premixed gases, eitheratmospheric air (<1% CO₂, 21% O₂, 79% N₂) or normoxic, hypercarbic gas(20% CO₂, 21% O₂, 59% N₂) began 1 min after placement of rats(n=8/group) in the cages and continued for 5 min. At that time the gasflow was terminated; the cages were opened; and rats were transferred totheir original home cages. Thirty min following the gas challenge ratswere anaesthetized and decapitated. Brains were removed and flash frozenin isopentane pre-cooled on dry ice. Brains were stored at −80° C. tillsectioned.

All equipment and working surfaces were kept RNase-free duringdissection of the regions of interest. Serial coronal brain sections(300 μm thickness) were cut using a cryostat (Leica) and placed onpre-cooled glass slides. The regions encompassing the orexin populationof neurons (DMH and LH) were dissected from two adjacent coronalsections between −2.8 to −3.4 mm bregma using tissue micropunches(inside diameter=1 mm) at specific locations. Tissues from themicropunches were placed directly into a lysis buffer (SurePrepRNA/DNA/Protein Purification Kit, Fisher Scientific, Hampton, N.H., USA)and stored at −80° C. until use. Total RNA was isolated using theSurePrep RNA/DNA/Protein Purification kit (Fisher Scientific, Cat. no.BP2802-50) using the manufacturer's protocol. Concentrations of sampleswere determined on a Nanodrop 1000 system (Thermo Scientific, Waltham,Mass., USA), and stored at −80° C. until conversion into cDNA. All totalRNA samples were diluted to the same concentration in nuclease-freewater (Ambion, Austin, Tex., USA, Cat no. AM9938) and then converted tocDNA with a High Capacity cDNA Reverse Transcription kit (AppliedBiosystems, Foster City, Calif., USA, cat. no. 4368814) in aMastercycler PCR machine (Eppendorf Inc., Hamburg, Germany) using themanufacturer's protocol. RT-PCR gene assays for prepro-ORX (AppliedBiosystems, Cat. no. Rn00565995) and beta actin (Applied Biosystems,Cat. no. 4352931E) were performed in triplicate using 3.5 ng cDNA foreach sample. RT-PCR assays were performed in a 7900HT Fast Real-Time PCRSystem (Applied Biosystems) and relative quantity of mRNA was calculatedby delta-deltaCt method using SDS v 2.3 software (Applied Biosystems)using beta actin expression as the normalization factor.

Rats exposed to hypercarbic gas had greater numbers of c-Fos/ORXA-irneurons in the DMH/PeF, but not LH, as compared to rats exposed toatmospheric air DMH/PeF (−2.94 mm bregma: gas infusion×regioninteraction, F_((1,12))=10.5, P=0.007; −3.12 mm bregma: gasinfusion×region interaction, F_((1,12))=11.1, P=0.006). The increase inc-Fos/ORXA-ir neurons occurred in the DMH/PeF (−2.94 mm bregma:F_((1,12))=11.2, P=0.006; −3.12 mm bregma: F_((1,12))=12.5, P=0.004,FIG. 29), but no effect was observed in the LH (−2.94 mm bregma:F_((1,12))=1.8, P=0.206 FIG. 28; −3.12 mm bregma: F_((1,12))=2.4,P=0.145, FIG. 1 c). There was no significant effect of gas exposure(−2.94 mm bregma: gas infusion×region interaction, F_((1,12))=2.9,P=0.114; −3.12 mm bregma: gas infusion×region interaction,F_((1,12))=0.02, P=0.901) on total numbers of ORXA-ir neurons in eitherthe DMH/PeF (−2.94 mm bregma: F_((1,12))=0.8, P=0.389 FIG. 28; −3.12 mmbregma: F_((1,12))=0.3, P=0.564, FIG. 29) or LH (−2.94 mm bregma:F_((1,12))=1.4, P=0.266 FIG. 28; −3.12 mm bregma: F_((1,12))=1.1,P=0.304, FIG. 29).

Hypercarbic Gas Exposure

In Experiment 12, the effects of this 5 min 20% CO₂/normoxic gaschallenge on O₂ and CO₂ concentrations in ambient air of experimentalcages have previously been described. Concentrations of O₂ remain at 21%throughout the gas infusion in the control and experimental cages. TheCO₂ concentration remains constant at <1. % in the control cage duringexposure of rats to atmospheric air (<1% CO₂/21% O₂/79% N₂). Infusion ofthe premixed normoxic, hypercarbic gas (20% CO₂/21% O₂/59% N₂) resultsin a rapid increase in CO₂ concentration from <1% CO₂ up to 20% CO₂ atthe 5 min time point. After terminating gas infusion and opening thecages the concentration of CO₂ rapidly decreases from 20% CO₂ to <2.5%CO₂ during the following 5 min.

Example Effects of an ORX1 Antagonist on Hypercarbic Gas-Induced Changesin Behavior and Cardiovascular Activity

All rats received hypercarbic gas infusions as described in detail inExperiment 11. However, 30 min prior to the hypercarbic gas challengerats were injected with vehicle (0.2 ml/100 g volume dimethyl sulfoxide(DMSO)) or a dose of an ORX1 receptor antagonist (30 mg/kg SB334867,Tocris Bioscience, Bristol, UK, in 0.2 ml/100 g volume DMSO, i.p.) thatblocks stress-induced anxiety-like behavior and panic-associatedcardioexcitatory responses without inducing somnolence. This drugcrosses the blood-brain barrier and does not alter MAP, HR or locomotoractivity in control rats. Blood pressure, heart rate, locomotoractivity, number of fecal pellets and anxiety-like behavior wereassessed as described in Experiment 11.

Compared to rats exposed to atmospheric gas, rats exposed to hypercarbicgas had reduced expression of ppORX mRNA in the combined DMH/PeF/LH(t₍₁₄₎=3.6, p=0.0028) (FIG. 30).

Statistical Analyses of Cardiovascular Responses and Open-FieldBehavior.

Dependent variables for analyses of cardiovascular responses (HR, MAP)and locomotor activity were analysed using a one-way ANOVA with repeatedmeasures, using gas infusion as the between-subjects factor and time asa within-subjects factor. Dependent variables for the number of fecalpellets and open-field anxiety test (i.e., time spent in each section,line crossings) were analysed using a one-way ANOVA with gas infusion inExperiment 11 and drug treatment in Experiment 12 as thebetween-subjects factors. In the presence of significant main effects ormain effect×time interactions, Fisher's Least Significant Difference(LSD) or paired t-tests were used for post-hoc pairwise comparisonssince each rat received both atmospheric and hypercarbic gas infusions(Experiment 11) or vehicle+hypercarbic gas or SB334867+hypercarbic gas(Experiment 12) on different days. Within-subjects comparisons were alsomade on the MAP and HR measures using a Dunnett's test for multiplecomparisons with a single control using the 5 Min baseline measurementas the control. The alpha level was set at 0.05 in all cases.

All statistical analyses were carried out using SYSTAT 5.02 (SYSTATInc., San Jose, Calif., USA) and SPSS14.0 (SPSS Inc., Chicago, Ill.,USA), and all graphs were generated using SigmaPlot 2001 (SPSS Inc.) andan illustration program (CorelDraw 11.633 for Windows, Viglen Ltd.,Alperton, UK).

Prior i.p. injections of SB334867, but not vehicle, attenuatedhypercarbic gas-induced changes in MAP (drug×time interactionF_((14,182))=6.4, P=0.0001; drug treatment effect F_((1,13))=11.0,P=0.029; the veh/CO₂, but not SB/CO₂, group had a within group timeeffect F_((14,105))=2.6, P=0.003, FIG. 31), but unexpectedly had noeffect on hypercarbic gas-induced bradycardia [drug×time interactionF_((14,182))=0.5, P=0.931; drug treatment effect F_((1,13))=1.0,P=0.346, with both the veh/CO₂ (F_((14,105))=9.8, P<0.001) and SB/CO₂(F_((14,90))=8.9, P<0.001) group having a within group time effect,FIGS. 31-32]. Neither the vehicle nor SB334867 treated rats had a changein locomotor responses over time prior to, during or after hypercarbicgas. Vehicle-treated rats exposed to hypercarbic gas had increasednumbers of fecal pellets, relative to atmospheric gas challenged controlrats, which was attenuated by SB334867 (SB/CO₂ group: F_((2,21))=5.6,P=0.012, FIG. 33). No significant differences in baseline MAP or HR(over 5 min initial atmospheric gas challenge prior to experimentalgases) were noted between treatment groups. However, rats pretreatedwith SB334867 did have higher locomotor activity prior to hypercarbicgas infusion than the vehicle-treated rats (t₍₆₎=−2.6, P=0.039). Thehypercarbic gas-treated group only had an n of 7 due to a malfunctioningtelemetry probe sending MAP and HR readings outside of the physiologicalrange on the last test day.

Open-Field Test

Vehicle-treated rats exposed to hypercarbic gas spent less time in themiddle perimeter area than vehicle-treated rats exposed to atmosphericair (F_((2,21))=3.6, P=0.045, FIG. 34). Although approachingsignificance with a Fisher's LSD post hoc test (protected by theprevious ANOVA result) comparing the Veh/CO₂ to the SB/CO₂ (p=0.056),comparing the Veh/CO₂ group to the SB/CO₂ group reveals that the SB/CO₂group spent significantly more time in the middle perimeter region thanthe Veh/CO₂ group (t₍₇₎=−2.7, p=0.016). No differences in the time spentin the center (F_((2,21))=0.2, p=0.790) or outer perimeter(F_((2,21))=0.2, P=0.085) regions were noted.

Example c-Fos/ORX Responses to Anxiogenic Drugs

c-Fos expression was examined, in combination with specificneurochemical markers, in the DMH/PeF region that may be involved inregulating the autonomic and behavioral responses to sodium lactate inintra-DMH/PeF 1-AG-treated rats.

Adult male Wistar rats (250-300 g; B&K Universal, Hull, UK) wereacclimatized to the animal facility for 1 week in group housing(four/cage), then single-housed on a 14:10-h light/dark cycle (lights onat 05:00 h) and habituated to the experimental room (36-48 h) before theexperiment. Food and water were provided ad libitum. Injections wereperformed using a completely randomized experimental design utilizing 16rats each day on 2 separate days (during the rats' inactive phase).

Time-matched groups of rats were injected between 09:00 and 17:00 h.Rats were injected i.p. with either saline vehicle (n=8), the 5-HT2A/2Creceptor agonist mCPP (Sigma, Dorset, UK; 5 mg/kg; n=6), the adenosinereceptor antagonist caffeine (Fluka, Dorset, UK; 50 mg/kg; n=6), the2-adrenoreceptor antagonist yohimbine (Sigma; 5 mg/kg; n=6), or thebenzodiazepine receptor inverse partial agonist FG-7142 (Tocris,Avonmouth, UK; 7.5 mg/kg; n=6). All drugs were dissolved in 0.9% saline,except for FG-7142, which was dissolved in 0.9% saline/40%2-hydroxypropyl-cyclodextrin (Tocris) to increase solubility as inprevious studies (Singewald et al., 2003; Singewald and Sharp, 2000).Each individual cage was placed under a video camera (model WVBP100B\W,Panasonic, Bracknell, UK). Behavior was recorded using an eight-waySprite multiplex video playback system and 24-h time lapse VCR(Philips-LDH8256-D and HS5424; Philips Communication, Security & ImagingB.V., Eindhoven, The Netherlands). Behavior was taped from 30 min beforeinjection until 2 h after injection. Rats were then anesthetized i.p.with sodium pentabarbitone (0.65 mg/kg) and transcardially perfused with4% paraformaldehyde in 0.1 M sodium phosphate buffer (PB). All buffersused were pH 7.4. Brains were removed, post-fixed in the same fixativefor 12 h, rinsed twice in PB (12 h), and placed in buffer comprising 30%sucrose in 0.1 M PB for 12 h. Brain tissues were blocked using astandard adult rat brain matrix (model RBM-4000C, ASI Instruments) andfrozen using liquid isopentane cooled by liquid nitrogen.

Statistical Analyses of Single ORX-ir and Double c-Fos/ORX-ir Neurons inand ORX mRNA

The dependent variables for cell counts (number of single ORXA-ir anddouble c-Fos/ORXA-ir cells) were analysed using a one-way ANOVA with gasexposure as the between-subjects factor and hypothalamic region as therepeated measure. In the presence of significant main effects or maineffect×brain region interactions, post-hoc tests were conducted todefine the anatomical location of the effects using an unpairedtwo-tailed t-test. In Experiment 12, ppORX mRNA expression from eachtreatment group was compared using an unpaired t-test. Statisticalsignificance was accepted at p<0.05.

Example Experiment 13: Effects of an ORX1 Receptor Antagonist onFG-7142-Induced Anxiety and Brain Responses

Animals and Housing Conditions

All experiments were conducted on adult male Wistar rats (250-300 g)purchased from Harlan Laboratories (Indianapolis, Ind. USA) and werehoused individually in plastic cages under standard environmentalconditions (22° C.; 12/12 light/dark cycle; lights on at 7:00 A.M.) for7-10 days prior to the surgical manipulations. Food and water wereprovided ad libitum.

In this experiment, rats were split into 3 drug treatment groups(n=8/group), where the rats each received the following: group 1) avehicle injection (0.2 ml DMSO in 100 g volume dH₂O) followed by anothervehicle (0.2 ml DMSO/0.1 ml TWEEN80 in 100 g volume dH₂O) withinjection; group 2) a vehicle injection followed by an inversebenzodiazepine agonist (FG-7142, 7.5 mg/kg ip, Sigma); or in group 3) anorexin 1 receptor antagonist (SB334867, 30 mg/kg ip, Tocris) followed byFG-7142. Fifteen min after the FG-7142 injection, all rats were testedfor anxiety behavior using a 5 min open field test (OFT); 5 min socialinteraction (SI) test; then a 5 min elevated plus maze (EPM) test.Ninety min following FG-7142 injections, rats were anaesthetized andthen the brains were removed and processed for immunohistochemistry asdescribed in detail in subsequent section.

Open-Field Behavior Anxiety Test (OFT)

The open-field arena covered an area of 90 cm×90 cm, with 40 cm highwalls. The open-field arena was divided into a 6×6 grid of equally-sizedsquares using black tape (36 total squares) with 4 squares forming thecentre; 12 squares forming the middle perimeter; and 20 squares formingthe outer perimeter. The test started by placing a rat in the centre.The behavior of each rat in the open-field arena was recorded on videoand scored afterwards by an observer blind to the experimental treatmentof each rat. Time spent in each region of the open-field was recorded.In addition, locomotor activity was assessed by counting the number oftimes the rat's entire body (excluding tail) completely crossed intoanother square.

Social Interaction Anxiety Test (SI)

A modified version of the social interaction (SI) test (File, 1980) wasutilized to measure anxiety-like responses. Following the OFT, theexperimental rat was placed in an open field (0.9 m long×0.9 m wide withwalls 0.3 m high) with an untreated novel partner rat. A video camerawas fixed above the box, and all behavioral tests were videotaped.During the 5 min test the total amount of time the treated rat initiatesinteraction with the partner rat is recorded (sniffing, grooming etc.)as described previously. Videotaped sessions were scored at a later timeby a SDF (blind to treatments) and a decrease in total interaction timewas taken as an increase in “anxiety” like behavior.

Elevated Plus Maze Anxiety Test (EPM)

Following the SI test, rats were place in the center area of the EPMwhere the two arms intersect. Unlike the SI test, the EPM measures manyrelevant anxiety related behaviors such as: no. of poke and full entriesinto and duration spent in closed versus open arm. The arena dimensionsare the following: each arm is 4.25″ wide and 19.75″ long, intersectionis 4.25″ by 4.25″, closed walls are 15.75″ high. Activity is measuredusing 38 state of the art photobeams (16× beams and 16 Y beams) toprovide the highest resolution system available (Automated EPM, HamiltonKinder Scientific, San diego, CA).

Perfusion

Ninety min following the initiation of treatment, rats wereanaesthetised with an overdose of sodium pentobarbital (40 mg, i.p.)then perfused transcardially with 0.05 M phosphate buffered saline (PBS;250 ml), followed by 0.1 M sodium phosphate buffer (PB; 250 ml)containing 4% paraformaldehyde (PFA) and 3% sucrose. Brains were removedand post-fixed for 24 h in the same fixative, rinsed for 24 h in 0.1 MPB, then placed in cryoprotectant (30% sucrose in 0.1 M PB) for anadditional 4-5 days. To maintain a consistent plane for coronalsections, brains were placed in a rat brain matrix (ASI instruments,Model No. RBM-4000C) and cut with a razor blade at the caudal border ofthe mammillary bodies. Brains were frozen in cooled liquid isopentanemade by immersing a plastic vessel containing isopentane into a dewarflask containing liquid nitrogen. Serial coronal sections (30 μm) werecut using a cryostat and were immediately placed in cryoprotectantconsisting of 27% ethylene glycol and 16% glycerol in 0.05 M PB to yieldsix alternate sets of sections. Sections were stored at −20° C. untilimmunohistochemical processing. All solutions had a pH of 7.4.

All brain sections were immunostained with the c-Fos primary antibody ina single immunohistochemical run, rather than in batches, with largevolume incubations to limit variability in the quality ofimmunohistochemical staining among brain sections. However, theforebrain was immunostained for c-Fos in one run and the brainstem(i.e., midbrain, pons and medulla) in another. Immunostaining for c-Fosprotein was accomplished using an affinity-purified primary antibodydirected at c-Fos (rabbit anti-human c-Fos polyclonal affinity-purifiedantibody, Cat. no. sc-52, Santa Cruz Biotechnology, San Diego, Calif.;diluted 1:10,000). Free-floating sections were washed in 0.1 M PBS for30 min, then incubated in 1% H₂O₂ in PBS for 20 min. Sections were thenwashed 10 min in PBS and 20 min in PBS with 0.3% Triton X-100 (PBST).Sections were then incubated 12-16 h in PBST with primary antibodysolution at room temperature. After a 30 min wash in PBST, sections wereincubated for 2 hr in biotinylated goat anti-rabbit IgG (Cat no.BA-1000, Vector Laboratories, Burlinghame, Calif.; diluted 1:500).Sections were washed again for 30 min in PBST then incubated 1.5 hr inan avidin-biotin-peroxidase complex provided in a standard Vector Elitekit (Cat no. PK-6100, Vector Laboratories, diluted 1:200). Theperoxidase substrate for the chromogen reaction was Vector SG, which wasprepared as recommended by the manufacturer (Cat. no. SK-4700, VectorLaboratories). The substrate reaction was run for 20 min for theforebrain. All sections were mounted on clean glass slides, driedovernight, dehydrated and mounted with coverslips using DPX mountingmedium (BDH Laboratory Supplies, Poole, UK). All washes and incubationswere done at room temperature in 12-well polystyrene plates with lowfrequency shaking on an orbital shaker.

Cell Counts

Selection of anatomical levels for analysis of c-Fos-immunostained cellswas conducted with reference to illustrations from a rat brainstereotaxic atlas (Paxinos and Watson, 1997). Selection of anatomicallevels was also done in reference to major anatomical landmarksincluding white matter tracts and the ventricular systems. Specifically,darkfield contrast [i.e., using a 1.6× Leica phase contrast Planobjective and Leica binocular microscope (model DMLB, Leica Mikroskopieand Systeme GmbH, Wetzler, Germany) with a darkfield condenser] was usedto visualise white matter tracts (e.g., the formix and optic tracts) andventricular systems (e.g., lateral, 3^(rd) and 4^(th) ventricles) thataided in selection of appropriate coronal levels with reference toillustrations in a standard stereotaxic atlas of the rat brain (Paxinosand Watson, 1997). The numbers of c-Fos-ir cells were counted in theentire field of view at 400× magnification (i.e., 10× eyepiece and 40×Plan objective) for each brain region. The regions selected for analysiswere as follows: bed nucleus of the stria terminalus (BNST) divisions(at +0.20 and −0.30 mm from bregma), and the intermediate part oflateral septum (LSI: at +0.20 and −0.30 mm from bregma), theparaventicular hypothalamic nucleus (PVN: −1.80 mm from bregma); theamygdala subdivisions [central amygdaloid nucleus (CeA); basolateralamygdaloid nucleus, anterior part (BLA); lateral amygdaloid nucleus(LA); and the medial amygdaloid nucleus (MeA) at −2.56 mm from bregma];and the dorsomedial hypothalamus (DMH), the periformical nucleus (PeF)(−3.14 mm from bregma), All cell counts were done by an observer (PLJ)that was blind to the experimental treatment of each animal.

Statistical Analyses

Analyses of Open-Field Behavior

Dependent variables for the open-field test (i.e., time spent in eachsection) were analysed using paired 2-tailed t-tests were used forpost-hoc pairwise comparisons since each rat received both atmosphericand hypercarbic gas infusions on different days. The two-tailed alphalevel was set at P<0.05 in all cases.

Statistical Analyses of Cell Counts

The dependent variable for cell counts (number of c-Fos-ir cells) wasanalyzed using a multifactor ANOVA with repeated measures with gasexposure as the between-subjects factor and brain region as thewithin-subjects factor. Missing values for multifactor ANOVAs withrepeated measures were calculated using the Peterson method (Peterson,1985); these values were not included in further post-hoc tests or ingraphical representations of the data. Missing values for c-Fos-ir cellcounts included 13 missing values out of 462 total values (approximately2.8%). In the presence of significant main effects or main effect×brainregion interactions, post-hoc tests were conducted to define theanatomical location of the effects using Fisher's Protected LeastSignificant Difference (Fisher's PLSD) tests for comparison of differentsubjects. Statistical significance was accepted at P<0.05. Allstatistical analyses were carried out using SYSTAT 5.02 (SYSTAT Inc.,San Jose, Calif.) and SPSS14.0 (SPSS Inc., Chicago, Ill.), and allgraphs were generated using SigmaPlot 2001 (SPSS Inc.) and anillustration program (CorelDraw 11.633 for Windows, Viglen Ltd.,Alperton, Middlesex, UK).

Photography

Photomicrographs were obtained using a brightfield microscope using NPlan 5×, 10×, 40× and 63× objective lenses (Leica binocular microscope,model DMLB), an Insight digital camera (Diagnostics Instruments Inc.,Sterling Heights, Mich., USA) and SPOT 3:5.5 for Windows digital imagingsoftware (Silicon Graphics, Mountain View, Calif., USA). Photographicplates were prepared in CorelDraw 11.633 for Windows.

Results

Using immunohistochemistry, both anxiogenic compounds increased cellularresponses in hypothalamic orexin neurons (FIG. 35). In the open fieldtest, the orexin 1 antagonist appeared to have attenuated FG-7142induced anxiety (FIG. 36). In the social interaction test, the orexin 1receptor antagonist blocked FG-7142-induced anxiety behavior (FIG. 37).In the elevated plus maze, anxiety behavior was noted in vehicle treatedcontrol and in the FG-7142 group (evidenced by low open arm times). Thismay be due to the repeated anxiety testing. However, the orexin 1antagonist treated rats had higher time in open arms indicative of ananxiolytic action.

TABLE 2 Mean number of c-Fos immunoreactive cells in brain regions inresponse to treatments. single c-Fos-ir cells veh/veh veh/FG SB/FG ILC(+2.60 mm bregma) 12 ± 2  12 ± 6  14 ± 8  PRL (+2.60 mm bregma) 5 ± 2 3± 1 2 ± 0 LSI (+0.20 mm bregma) 16 ± 4  12 ± 4  10 ± 4  PeF (−3.14 mmbregma) 31 ± 8  67 ± 23 65 ± 20 Amygdala (−2.56 mm bregma) BLA 8 ± 4 9 ±4 6 ± 2 MeA 72 ± 14 85 ± 18 91 ± 21 LA 7 ± 2 10 ± 4  6 ± 1 DRN (−7.80 mmbregma) 1 ± 0 1 ± 0 1 ± 0 IPBN (−9.30 mm bregma) 11 ± 7  9 ± 3 10 ± 3 mPBN (−9.30 mm bregma) 3 ± 1 3 ± 1 2 ± 1 LC (−10.04 mm bregma) 45 ± 8 48 ± 5  45 ± 9 

1. A method of reducing one or more symptoms associated with panicdisorder in an individual, the method comprising administering to theindividual suffering from panic disorder a composition comprising atherapeutically effective amount of an agent to down regulate theactivity an orexin, selected from Orexin A or Orexin B, at one or moreorexin receptors.
 2. A method of treating symptoms associated withhypercapnia or a hypercapnic condition in an individual, the methodcomprising administering to the individual a composition comprising atherapeutically effective amount of an agent to down regulate theactivity of an orexin, selected from Orexin A or Orexin B, at one ormore orexin receptors. 3.-4. (canceled)
 5. The method of claim 2 whereinorexin receptor activity is down regulated at an orexin 1 receptor. 6.The method of claim 2 wherein orexin receptor activity is down regulatedat an orexin 2 receptor.
 7. The method of claim 2 wherein the orexinreceptor activity is down regulated at both orexin 1 and orexin 2receptors.
 8. The method of claim 2 wherein expression of prepro-orexinis decreased.
 9. The method of claim 8 wherein the expression isdecreased by a siRNA.
 10. The method of claim 2 wherein expression of anorexin receptor is decreased.
 11. The method of claim 10 wherein theexpression is decreased by a siRNA.
 12. The method of claim 2 whereinthe agent comprises an orexin receptor antagonist selected from thegroup consisting of an orexin receptor antagonist selective for orexin 1receptors; an orexin receptor antagonist selective for orexin 2receptors; and an orexin receptor antagonist having affinity at orexin 1receptors and orexin 2 receptors. 13.-16. (canceled)
 17. The method ofclaim 12 wherein the orexin receptor antagonist is selected fromSB334867, SB408124, MK4305, and almorexant.
 18. The method of claim 2wherein the agent comprises an antagonistic antibody.
 19. The method ofclaim 18 wherein the antibody is a single chain antibody fragment. 20.The method of claim 2 wherein the hypercapnic condition is selected fromchronic pulmonary disease, chronic obstructive pulmonary disease (COPD),obstructive sleep apnea syndrome (OSAS), congestive heart failure,sarcoidosis, and/or Pickwick's syndrome.
 21. The method of claim 2wherein hypercapnia symptom is selected from hypertension, anxiety,elevated sympathetic nervous system activity, elevated respiration, andcombinations thereof. 22-23. (canceled)
 24. A method of determiningwhether an individual is responsive to a treatment for panic disorder ora hypercapnic associated disorder, the method comprising determining thelevels of orexin in a biological sample from the individual obtainedprior to said treatment; administering said treatment; determining thelevels of orexin in a biological sample from the individual during orafter said treatment period, comparing the levels of orexin present inthe sample obtained after initiating treatment to baseline levels oforexin present in the sample obtained prior to treatment, anddetermining that the individual is responsive to treatment if orexinlevels are reduced during or after said treatment period.
 25. The methodof claim 24 wherein the biological sample is cerebrospinal fluid. 26.(canceled)